A 24 year old white male was brought to the Emergency room complaining of headaches of one weekÕs duration that were getting progressively worse, photophobia, lethargy, and a fever of 39C. His friend that brought him said that he fell trying to get into the car. He also tells you that his friend has AIDS and that his latest CD4 count was 150. While you were examining him, the patient fell asleep several times. You ordered a chest x-ray and a head CAT scan. Both were normal.
Question 1 - Single Best Answer
What are some common causes of central nervous system infection in AIDS patients?
HIV, EEEV, Cryptosporidium Neisseria meningitidis, Streptococcus agalactiae, Streptococcus pneumoniae Cryptosporidium, Cryptococcus, Cyclospora Cryptococcus, HIV, Toxoplasma Treponema pallidum, Toxoplasma, Trichomonas
To determine the cause of this patientÕs problem you consider doing a lumbar puncture.
Question 2 - Single Best Answer
If you consider a lumbar puncture, which of the following is the best procedure?
DO IT wait for 24 hours before doing this invasive procedure to see if the patient improves do a blood culture first
You performed a lumbar puncture and found some white cells with a preponderance of lymphocytes, moderately low glucose, (22mg/dl), and moderately high protein (89mg/dl).
Question 3 - Single Best Answer
This is typical of which of the following?
no infection untreated bacterial infection viral infection fungal infection
Question 4 - Single Best Answer
What is the major way that the CSF profile for a bacterial infection differs from that of a fungal infection?
the glucose level is higher the protein level is lower there are no WBCÕs in a bacterial infection there are more polys in a bacterial infection
Question 5 - Single Best Answer
The patient had a lower number of WBCÕs in the CSF than is usual for a patient with cryptococcal meningitis. What might be the reason for this?
he had AIDS he had a worse than normal case of cyrptococcus he had a less serious than normal case of cyrptococcus
When you are able to further question the patient, you learn that one of his hobbies is feeding the pigeons in the town square.
Question 6 - Single Best Answer
What disease is most frequently associated with pigeons?
histoplasmosis coccidioidomycosis parrot fever sporotrichosis cryptococcosis
Question 7 - Single Best Answer
To confirm a diagnosis of cryptococcal meningitis, which of the following would you do?
look for serum IgG look for serum IgM grow the organism from the spinal fluid india ink stain of the spinal fluid do a latex agglutination test to look for cryptococcal antigen
The patientÕs CSF was mixed with latex particles coated with rabbit anticryptococcal antibody and also with latex particles coated with non-immune rabbit serum. Agglutination was observed only when anticryptococcal antibody was present, confirming a diagnosis of cryptococcal meningitis.
Question 8 - Single Best Answer
The nonimmune control is done to detect false positive reactions caused by
rheumatoid factor anticardiolipin antibody antibody against Proteus antibody against histoplasma antibody against coccidioides
Question 9 - Single Best Answer
What is the major virulence factor of cryptococcus against which the anticryptococcal antibody is directed?
chitin peptidoglycan nuclear membrane capsule pili
Question 10 - Single Best Answer
What is the portal of entry for cryptococcus?
blood via an insect vector skin via an epidermal hydrolase ingestion of undercooked pigeon meat inhalation of mold particles inhalation of yeast spores
Question 11 - Single Best Answer
How does cryptococcus get from the lung to the brain?
retrograde axonal transport hematogenously by invasion of macrophages which are carried to the brain
Question 12 - Single Best Answer
What is the best treatment for cryptococcal meningitis in an AIDS patient?
clindamycin penicillin G amphotericin B 5-flourocytosine combination of amphotericin B and 5-flourocytosine
Question 13 - Single Best Answer
How is the progress of the therapy followed?
improvement of symptoms rise in serum antibodies fall in serum antigen concentration fall in CSF antigen concentration
Question 14 - Single Best Answer
What is this patientÕs prognosis?
excellent good poor very poor
Question 15 - Single Best Answer
Do patients that are not immunosuppressed ever develop cryptococcal meningitis?
yes no
Question 16 - Single Best Answer
What are some less common presentations of cryptococcal disease?
lower respiratory tract disease skin nodules bone infections all of the above
Question 17 - Single Best Answer
What is the geographic distribution of Cryptococcus neoformans, the agent of this manÕs disease?
it is only found in Africa it is only found in the "New World" it is only found in arid regions of the world it is only found in the Mississippi River and Ohio River valleys it has worldwide distribution