A 16-year-old boy is brought to the emergency department via ambulance. The school nurse who accompanied him informs the physician that he has had 2 days of headache and generalized body aches that did not respond to acetaminophen. He felt well enough to attend school and to work his part-time job at a local hardware store. However, this morning his headache worsened and he was extremely drowsy. The paramedics administered intravenous normal saline; no other interventions were required during transport. In the emergency department, he becomes lethargic, has a seizure, and is immediately intubated by the resident physician. Subsequent evaluation reveals that the patient is suffering from acute meningococcal meningitis.
In addition to the patient's family members, which of the following contacts requires antibiotic prophylaxis to prevent the development of meningococcal meningitis?

Question

A 16-year-old boy is brought to the emergency department via ambulance.  The school nurse who accompanied him informs the physician that he has had 2 days of headache and generalized body aches that did not respond to acetaminophen.  He felt well enough to attend school and to work his part-time job at a local hardware store.  However, this morning his headache worsened and he was extremely drowsy.  The paramedics administered intravenous normal saline; no other interventions were required during transport.  In the emergency department, he becomes lethargic, has a seizure, and is immediately intubated by the resident physician.  Subsequent evaluation reveals that the patient is suffering from acute meningococcal meningitis. 
In addition to the patient's family members, which of the following contacts requires antibiotic prophylaxis to prevent the development of meningococcal meningitis?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfaf_743b_8f63_f147d2d2c6ef_MD0005_00 Neisseria meningitidis is the most common cause of acute bacterial meningitis in children and adolescents age 2-18. N meningitidis attaches to the nasopharyngeal epithelium, where it can replicate asymptomatically or cause invasive disease. Mucosal invasion is followed by bacteremia, leading to sepsis, meningitis, or both. Meningococcal meningitis is a devastating illness associated with significant morbidity and mortality. Antibiotic chemoprophylaxis can prevent its spread and is indicated for high-risk contacts. These include those who live in the same household or who have had prolonged, close contact with a patient and his or her secretions (eg, roommates, significant others). In addition, all health care workers who have had direct exposure to the patient's respiratory secretions (ie, during suctioning or intubation) should receive chemoprophylaxis. Finally, child care workers require prophylaxis due to the increased risk of exposure to the saliva of a pre-school aged child. (Choices A, B, C, and D) Low-risk contacts do not require antibiotic prophylaxis. These include casual contacts (such as co-workers, classmates, or teachers) and health care providers who were briefly exposed to the patient but had no direct contact with secretions (eg, the paramedic who drove the ambulance and the emergency department staff who were not involved in this patient's care). Individuals who have direct contact with a high-risk contact but not the patient are also considered low-risk (eg, the babysitter of a patient's younger sibling). Educational objective: All household contacts or other individuals with prolonged, close contact or direct exposure to the respiratory secretions of a patient with meningococcal meningitis should receive antibiotic prophylaxis to prevent its spread and development. References: Severe meningococcal infection: a review of epidemiology, diagnosis, and management (http://www.ncbi.nlm.nih.gov/pubmed/23830646) Prevention of meningococcal disease (http://www.ncbi.nlm.nih.gov/pubmed/16342836)

A 16-Year-Old Boy Is Brought to the Emergency Department Via