Neurologic Disorders Case

A 10-day-old male infant is admitted to the pediatric intensive care unit (PICU) for fever, seizures, and somnolence.

May 15, 2019
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His anterior fontanelle is full. A CT scan of the head did not show acute abnormalities. CSF showed elevated white blood cells with mostly neutrophils, elevated protein, and low glucose. You suspect meningitis and start antibiotics.

What are the most likely organisms in a patient of this age?

A. Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b.

B. N. meningitidis, S. pneumoniae.

C. Group B Streptococcus, Escherichia coli, Listeria monocytogenes.

D. S. pneumoniae, N. meningitidis, L. monocytogenes.




The correct answer is “C.” It is important to know the common organisms causing acute bacterial meningitis in each age group. (See Table 23–2.) The most common causes of meningitis in a newborn are group B StreptococcusE. coli, and Listeria. The typical empiric antibiotic regimen for neonatal meningitis is ampicillin and cefotaxime or gentamycin. Listeria is resistant to cephalosporins, which is why you need to include ampicillin. Group B Streptococcus is sensitive to penicillins. E. coli is a gram-negative rod, and is covered by cefotaxime and gentamycin.


Sources:

Question & Explanation: Peterson AR, Wood KE. Pediatrics Examination and Board Review. New York, NY: McGraw-Hill Education; 2017.

Photo: Wells RG. Diagnostic Imaging of Infants and Children; 2015

Leah Carton

Editorial Coordinator , McGraw-Hill Education

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