A 21-year-old woman comes to the emergency department due to fever and headache. The patient began having myalgias 12 hours ago and then rapidly developed fever, progressive headache, nausea, and several episodes of vomiting. She has had no cough, dyspnea, diarrhea, or dysuria. The patient has no prior medical issues and takes no medications. She is a college student and lives in a dormitory on campus. She has not traveled recently and does not know if she has been exposed to sick contacts. The patient drinks 2-4 beers on weekends and does not use tobacco or illicit drugs.
Temperature is 39.2 C (102.7 F), blood pressure is 106/68 mm Hg, pulse is 115/min, and respirations are 20/min. The patient is ill-appearing with scattered petechial skin rash. No sinus tenderness is present, and the oropharyngeal mucosa is moist with no lesions. Auscultation of the heart and lungs is normal. She has neck rigidity but no other focal neurological deficits. Funduscopy shows no papilledema.
Which of the following infection-control measures is most appropriate at the present time for this patient?

Question

A 21-year-old woman comes to the emergency department due to fever and headache.  The patient began having myalgias 12 hours ago and then rapidly developed fever, progressive headache, nausea, and several episodes of vomiting.  She has had no cough, dyspnea, diarrhea, or dysuria.  The patient has no prior medical issues and takes no medications.  She is a college student and lives in a dormitory on campus.  She has not traveled recently and does not know if she has been exposed to sick contacts.  The patient drinks 2-4 beers on weekends and does not use tobacco or illicit drugs.
Temperature is 39.2 C (102.7 F), blood pressure is 106/68 mm Hg, pulse is 115/min, and respirations are 20/min.  The patient is ill-appearing with scattered petechial skin rash.  No sinus tenderness is present, and the oropharyngeal mucosa is moist with no lesions.  Auscultation of the heart and lungs is normal.  She has neck rigidity but no other focal neurological deficits.  Funduscopy shows no papilledema.
Which of the following infection-control measures is most appropriate at the present time for this patient?

Quizplus · Accepted Answer

11ec193a_964e_b217_853d_932bf868f220_MD0002_00 Neisseria meningitidis is the leading cause of community-acquired bacterial meningitis in children and young adults. Most cases begin with severe myalgias followed by a petechial/hemorrhagic rash, fever, and meningeal signs. Patients often deteriorate rapidly and usually present ≤22 hours after symptom onset. N meningitidis is transmitted by aerosolized droplets and is highly contagious; all patients with suspected meningococcal meningitis should be put on droplet precautions for at least 24 hours after the initiation of antimicrobial therapy. As part of these precautions, health care personnel should wear surgical masks when they are within 6 feet of the patient. (Choice A) Contact precautions are typically used to prevent spread of multidrug resistant bacteria (eg, methicillin-resistant Staphylococcus aureus) and some enteric organisms such as Clostridium difficile. Gloves and gowns are required for interaction with the patient. (Choice B) Airborne isolation involves a negative air pressure room and is typically used for organisms that are transmitted by airborne droplet nuclei (<5 microns) such as tuberculosis, varicella, and measles. Droplet nuclei are smaller than aerosolized droplets and can stay suspended in the air for several hours; as such, droplet nuclei require airborne isolation whereas aerosolized droplets do not. (Choice C) Standard precautions should be used in the care of all patients and include hand hygiene, gowns/glove/eye protection if exposure to fluids is likely, and safe injection practices. This patient with likely meningococcal meningitis requires droplet precautions in addition to standard precautions. (Choice D) Potential C difficile infection requires the use of soap and water for hand hygiene as alcohol-based hand rubs do not eradicate C difficile spores. This patient does not have watery diarrhea or risk factors for C difficile (eg, recent antimicrobial therapy). Educational objective: Patients with potential meningococcal meningitis require at least 24 hours of droplet precautions after the initiation of antibiotics in order to prevent transmission to individuals in close contact. Droplet precautions include the use of a surgical mask when an individual is within 6 feet of the source patients. __________

A 21-Year-Old Woman Comes to the Emergency Department Due to Fever