1 infec 92 - tabish60102

[ArchivalUser]

A 16-year-old boy develops increasing redness, pain, and swelling around an abraded area on his right arm acquired during a high school wrestling match. He subsequently becomes febrile, lightheaded, and confused and is brought to the emergency department.

On physical examination, temperature is 37.9 °C (100.2 °F), pulse rate is 108/min, respiration rate is 22/min, and blood pressure is 110/79 mm Hg. Marked swelling and erythema are present from the right mid-forearm to the shoulder. There are also areas of pale skin suggestive of early necrosis. The remainder of the examination is unremarkable.

Laboratory Studies
Leukocyte count

23,000/μL (23 × 109/L) with 92% neutrophils, 7% lymphocytes, and 1% monocytes
Blood urea nitrogen

14 mg/dL (5 mmol/L)
Serum creatinine

0.7 mg/dL (61.89 µmol/L)
Serum electrolytes

Normal
Liver chemistry studies

Normal
Renal function studies

Normal

Blood cultures grow gram-positive cocci in chains.

Which of the following prophylactic regimens should be offered to household contacts?

A Oral penicillin V
B Intramuscular benzathine penicillin
C Throat cultures followed by oral penicillin V
D Throat cultures followed by intramuscular benzathine penicillin
E No prophylaxis or cultures are required

[ArchivalUser]

A)???

[ArchivalUser]

ee

[ArchivalUser]

EE

[ArchivalUser]

EE

[ArchivalUser]

Correct Answer = E)
Key Points

* Prophylaxis is not required for household contacts of patients with an invasive streptococcal infection.
* If two or more cases of invasive streptococcal disease occur in postpartum or postsurgical patients hospitalized within 6 months in the same institution, an epidemiologic investigation is required to determine if a hospital worker is a carrier.

This patient most likely has an invasive group A streptococcal infection. An expert panel sponsored by the U.S. Centers for Disease Control and Prevention reviewed available data and concluded that close contacts (family members and health care workers) of an individual with invasive streptococcal infection were not at increased risk for contracting the infection. Therefore, prophylaxis is not required for household contacts. In addition, throat cultures are not needed because none of the family members is likely to be at increased risk of infection.

Health care workers in contact with the patient also do not require prophylaxis. However, if two or more cases of invasive streptococcal disease occur in postpartum or postsurgical patients who were hospitalized within 6 months in the same institution, an epidemiologic investigation should be performed to determine if a hospital worker is a carrier and therefore poses a risk to patients.
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