The following describes your patient’s clinical presentation: A 19-year-old Cauc

Question

The following describes your patient’s clinical presentation:

A 19-year-old Caucasian female in her first year at University presented in A&E with confusion, irritability, marked neck stiffness, petechial rash and a body temperature of 38.5oC. In the preceding 24h, the patient had experienced a severe occipital headache with vomiting. A CSF sample was then obtained by lumbar puncture and analysed and the results obtained are shown in Table A:

Table A: Results of the analysis of the patient’s CSF sample

Parameter measured

Result

Reference range

Appearance

Cloudy & turbid

Clear & colourless

Protein

5.2 g/L

0.2 – 0.4 g/L

Glucose mmol/L

0.18 mmol/L

3.3 – 4.4 mmol/L

White cells

4800 x 106/L

97% neutrophils

0 – 5 x 106/L

All lymphocytes

No neutrophils

Red Cells

6.2 x 106/L

0 – 10 x 106/L

Microbiology

Positive for Neisseria meningitides

N/A

The patient was treated with intravenous cefotaxime and made a full recovery. The patient then reported a previous N. meningitides infection at aged 13 years with N. meningitides serogroup Y so, following recovery, further investigations were undertaken to evaluate her immune function. The results obtained are presented in Table B:

Table B: Results of immune screen

Parameter

Result

Reference Range

Serum IgG

12.1 g/L

6.0 – 16.0 g/L

Serum IgA

2.8 g/L

0.8 – 4.0 g/L

Serum IgM

1.2 g/L

0.5 – 2.0 g/L

AH50

0 units

80 – 200 units/mL

CH50

0.6

100- 500 units/mL

Based on the above and in light of the results you have obtained, what possible underlying cause(s) have led to the patient’s reduced resistance to N. meningitides? Explain your rationale.

Parameter measured

Result

Reference range

Appearance

Cloudy & turbid

Clear & colourless

Protein

5.2 g/L

0.2 – 0.4 g/L

Glucose mmol/L

0.18 mmol/L

3.3 – 4.4 mmol/L

White cells

4800 x 106/L

97% neutrophils

0 – 5 x 106/L

All lymphocytes

No neutrophils

Red Cells

6.2 x 106/L

0 – 10 x 106/L

Microbiology

Positive for Neisseria meningitides

N/A

Explanation / Answer

Neisseria meningitidis is a gram-negative diplococcus that is closely related to the gonococcus. It causes a spectrum of disease, ranging from transient fever and bacteremia to meningitis and fulminant septicemia.

according to the given data the person is suffered with severe occipital headache with vomiting and she is get cured from this by using intravenous cefotaxime.( now she is adult so she had well developed immune system thats why recovery has happend )

at the age of 13 she get N. meningitides infection in that time she didnt get cure and she had reduced resistance to N. meningitides because of her immune system.one of the reason behind that is --- in that time she is younger so her immune system is not developed properly thats why she had reduced resistance to N. meningitides infection.

N. meningitidis isolates showed resistance to ciprofloxacin, the DNA gyrase A quinolone-resistance–determining regions (QRDRs) of 2 ciprofloxacin-sensitive and 7 ciprofloxacin-resistant meningococcal strains.

The MIC pattern of the clinical isolates of N. meningitidis from they were susceptible to -lactam antibiotics penicillin, ampicillin, and a third-generation cephalosporin, ceftriaxone. The MIC against ceftriaxone for all the clinical N. meningitidis isolates was <0.001 µg/mL. Of 14 strains, 12 showed decreased susceptibility to all the fluoroquinolones, especially to ciprofloxacin (MIC 0.25 µg/mL).

another reason is at the age of 13 she didnt get cure because the bacteria has drug resistance thats why most of the bacteria has not killed and after few years later the bacteria went to relapsing condition.so she might be infected because of this reason.

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