ID Board Review Question

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 Please submit your answer to: holly_murphy@ihacares.com. The first to answer and the first to answer correctly will be rewarded with a treat.

 

A 51 yo man was seen in the emergency room in New Orleans for a headache for one day.

 

He lives on a farm outside of the city and eats raw goat’s milk. Two days prior to presentation he drove his truck into a lake and ingested a fair amount of water and had an injury to his leg as he tried to pry open the door and get out of the vehicle. He denied trauma to the head. He was awake, alert and oriented but had a stiff neck.  The rest of the exam was unremarkable.

 

CSF showed the following:

 

WBC 1672 (85% neutrophils)

RBC 50

Glucose 22

Protein 480

Gram stain negative

 

He was treated with dexamethasone, vancomycin and ceftriaxone for suspected bacterial meningitis.  The following day he worsened with confusion, vomiting.  Cultures of CSF were negative at 72 hours.

 

What is the most likely etiology?

 

A.    Acanthamoeba castellanii

B.    Balamuthia mandrillaris

C.     Pythium insidiosa

D.    Naegleria fowleri

E.     Paracappillaria philippinensis



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