A 16-day-old infant presents with fever, irritability, poor feeding, and a bulging fontanelle. Spin

Discussion in 'MRCPCH forum' started by samuel, Sep 19, 2014.

  1. samuel

    samuel New Member

    A 16-day-old infant presents with fever, irritability, poor feeding, and
    a bulging fontanelle. Spinal fluid demonstrates gram-positive cocci. Which
    of the following is the most likely diagnosis?
    a. Listeria monocytogenes
    b. Group A streptococci
    c. Group B streptococci
    d. Streptococcus pneumoniae
    e. Staphylococcus aureus
  2. samuel

    samuel New Member

    The ans is C:
    Many organisms can cause meningitis in the neonate, includingE coli, L monocytogenes, H influenzae,gram-negative rods, group B and D streptococci, and coagulase-positive and coagulase-negative staphylococci; statistically, the most likely cause in this case is late-onset group B streptococci (GBS). Early onset GBS is seen in the first 7 days of life and is associated with maternal complications such as prolonged rupture and chorioamnionitis; late onset GBS occurs after 7 days of life and is not related to maternal issues but rather environmental exposures. As expected, the incidence of early onset GBS has been steadily dropping with maternal prophylaxis; the incidence of late onset GBS has remained unchanged during the same time period. Clinical manifestations of meningitis in neonates include lethargy, bulging fontanelle, seizures, and nuchal rigidity. The diagnosis is made with examination and culture of the CSF. Treatment is begun while awaiting the results of the spinal fluid analysis. Appropriate initial antibiotic coverage must include activity against gram-positive and gram-negative organisms (ampicillin and gentamicin or ampicillin and cefotaxime).

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