Question:
This 19-year old student was in his usual state of health until theevening prior to admission, when he went to bed with a headache. Hetold his mother that he felt feverish, and on the following morninghis mother found him in bed, moaning and lethargic. He was broughtto the emergency room, where he appeared toxic and drowsy butoriented. His temperature 40'C, his heart rate was 126/min, and hisblood pressure was 100/60 mm Hg. His neck was supple. He had animpressive purpuric rash, not blanching, most prominent on thetrunk, legs and wrists. His white blood cell count was 26,000/ulwith 25% band forms. The platelet count was 80,000/ul.
Blood cultureswere obtained, a lumbar puncture was performed, and the patient wasbegun on intravenous ceftriaxone. Cerebrospinal fluid (CSF)glucose, protein, and white blood cell count were normal, and CSFbacterial culture was negative. Blood cultures grew a Gram Negativediplococci.
1. What is the organism causing his illness? Is the finding of anormal CSF profile without evidence of meningitis commonly observedin infection with this organism? Explain.
2. Is this organism ever part of the normal oropharyngealmicrobiota? Explain.
3. How is this disease spread? How can infection beprevented?
4. What is a purpuric rash, and which virulence factor plays acentral role responsible for its appearance?
Question:
This 19-year old student was in his usual state of health until theevening prior to admission, when he went to bed with a headache. Hetold his mother that he felt feverish, and on the following morninghis mother found him in bed, moaning and lethargic. He was broughtto the emergency room, where he appeared toxic and drowsy butoriented. His temperature 40'C, his heart rate was 126/min, and hisblood pressure was 100/60 mm Hg. His neck was supple. He had animpressive purpuric rash, not blanching, most prominent on thetrunk, legs and wrists. His white blood cell count was 26,000/ulwith 25% band forms. The platelet count was 80,000/ul.
Blood cultureswere obtained, a lumbar puncture was performed, and the patient wasbegun on intravenous ceftriaxone. Cerebrospinal fluid (CSF)glucose, protein, and white blood cell count were normal, and CSFbacterial culture was negative. Blood cultures grew a Gram Negativediplococci.
1. What is the organism causing his illness? Is the finding of anormal CSF profile without evidence of meningitis commonly observedin infection with this organism? Explain.
2. Is this organism ever part of the normal oropharyngealmicrobiota? Explain.
3. How is this disease spread? How can infection beprevented?
4. What is a purpuric rash, and which virulence factor plays acentral role responsible for its appearance?
