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. The patient became increasingly confused throughout the morning and eventually unarousable, prompting him to call an ambulance.
After initial evaluation, lumbar puncture is performed and empiric antibiotic therapy is started. Cerebral spinal fluid shows Gram-negative diplococci. She is admitted to the intensive care unit.
Which of the following individuals needs antibiotics for post-exposure prophylaxis?

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.  The patient became increasingly confused throughout the morning and eventually unarousable, prompting him to call an ambulance.
After initial evaluation, lumbar puncture is performed and empiric antibiotic therapy is started.  Cerebral spinal fluid shows Gram-negative diplococci.  She is admitted to the intensive care unit.
Which of the following individuals needs antibiotics for post-exposure prophylaxis?

Quizplus · Accepted Answer

11ec193a_9645_1515_853d_5b3707b67a5f_MD0002_00 This patient's presentation of fever, rash, decreased level of consciousness and Gram-negative diplococci on lumbar puncture suggests likely meningococcal infection from Neisseria meningitidis. Meningococcus usually spreads through droplets of respiratory secretions and can transmit rapidly to contacts within close proximity (3-6 feet). Individuals require antibiotic prophylaxis if they have close contact and prolonged duration (> 8 hours) regardless of vaccination status. Healthcare workers (with close proximity and prolonged duration or exposure to respiratory secretions) and close contacts of infected patients with meningococcal disease ideally should receive antibiotic chemoprophylaxis within the first 24 hours of the patient's diagnosis. Exposure usually occurs during the week prior to onset of symptoms or 24 hours prior to antimicrobial therapy. Recommended regimens include rifampin, ciprofloxacin, or ceftriaxone. This patient's boyfriend would warrant antimicrobial therapy. (Choices A, B, and D) The nurse, medical resident, and transporter would need antibiotic prophylaxis only if they were exposed to respiratory secretions or were in very close proximity to the secretions for a prolonged period. These workers had a relatively short duration of exposure and would benefit less from antibiotic prophylaxis. If this patient required intubation, the physician who performed it would require antimicrobial prophylaxis. Educational objective: Regardless of vaccination status, healthcare workers (with close proximity and prolonged duration or exposure to respiratory secretions) and close contacts of infected patients with meningococcal disease should receive antibiotic chemoprophylaxis, ideally within the first 24 hours of patient diagnosis. Recommended regimens include rifampin, ciprofloxacin, or ceftriaxone. __________ 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