A 23-year-old woman is brought to the emergency department with fever, rash, and decreased level of consciousness. She is accompanied by her boyfriend. Throughout the morning, she became increasingly confused and eventually unarousable, prompting him to call an ambulance. He does not know of any specific medical problems but reports that the patient had abdominal surgery after a bad automobile accident. After initial evaluation, lumbar puncture is performed and empiric antibiotic therapy is started. Cerebral spinal fluid shows Gram-negative diplococci. The patient is transferred to the intensive care unit.
Which of the following is the best initial choice for infectious precaution measures?

Question

A 23-year-old woman is brought to the emergency department with fever, rash, and decreased level of consciousness.  She is accompanied by her boyfriend.  Throughout the morning, she became increasingly confused and eventually unarousable, prompting him to call an ambulance.  He does not know of any specific medical problems but reports that the patient had abdominal surgery after a bad automobile accident.  After initial evaluation, lumbar puncture is performed and empiric antibiotic therapy is started.  Cerebral spinal fluid shows Gram-negative diplococci.  The patient is transferred to the intensive care unit.
Which of the following is the best initial choice for infectious precaution measures?

Quizplus · Accepted Answer

11ec193a_9644_c6f4_853d_73da2c28c147_MD0002_00 Meningococcal infection should be suspected in a young patient who presents with fever, rash, decreased level of consciousness, and Gram-negative diplococci in the spinal fluid. A history of abdominal surgery and possible splenectomy also increases the risk of meningococcal disease. Droplet precautions and antibiotic chemoprophylaxis should be instituted for those in close contact with the patient (eg, family members, healthcare workers). Droplet precautions should be in effect for the first 24 hours of antimicrobial therapy and involve wearing a facemask if within 6-10 feet of the patient. Use of a higher-level respirator mask or closing the door of the patient's room is not necessary. Rifampin, ciprofloxacin, and ceftriaxone are the recommended antibiotic chemoprophylaxis drugs for persons at risk. persons at risk (Choices A, B, and D) Neisseria meningitidis is transmitted via droplets. Unlike infectious agents transmitted in an airborne mode, it usually does not spread more than 3 feet. Educational objective: For patients with meningococcal infection, droplet precautions should be in effect for the first 24 hours of antimicrobial therapy and involve wearing a facemask if within 6-10 feet of the patient. Rifampin, ciprofloxacin, and ceftriaxone are recommended antibiotic chemoprophylaxis drugs for persons at risk. __________ References: Prevention and control of meningococcal disease. recommendations of the Advisory Committee on Immunization Practices (ACIP). (http://www.ncbi.nlm.nih.gov/pubmed/15917737)

A 23-Year-Old Woman Is Brought to the Emergency Department with Fever