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| * q21 |
| | #137996 |
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21. A 42-year-old man comes to the emergency department because of a 2-week history of increasingly severe headaches and a 2-day history of nausea, vomiting, neck stiffness, and unsteadiness. He has type 2 diabetes mellitus treated with glyburide. His temperature is 38.1 C (100.5 F). Funduscopic examination shows bilateral papilledema. Neurologic examination shows mild meningismus and diffusely brisk deep tendon reflexes. He walks with a moderately broad-based gait. He is able to recall two out of three objects after 5 minutes and makes several errors on serial sevens. A CT scan of the head shows no abnormalities. Cerebrospinal fluid analysis shows a glucose level of 18 mg/dL, a protein level of 108 mg/dL, and a leukocyte count of 59/mm3 (1% segmented neutrophils and 99% lymphocytes); a cryptococcal antigen assay is positive. Which of the following is the most appropriate pharmacotherapy for this patient?
A
) Acyclovir
B
) Amphotericin B
C
) Itraconazole
D
) Penicillin
E
) Vancomycin
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| * Re:q21 |
| #555966 |
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whats the diagnosis? apart from the meningitis? why does he have neutropenia.... |
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| * Re:q21 |
| #555978 |
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Patients with high initial CSF pressure, decreased CSF glucose, low CSF leukocyte count , no cryptococcal antibody or high cryptococcal antigen titers tend to have a poor prognosis. Patients with low initial CSF pressure, higher CSF leukocyte counts, cryptococcal antibodies and low cryptococcal antigen levels tend to fare better .
cryptococcal meningitis common in HIV pt |
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