Question

A 35-year-old man was hospitalized because of headache, fever, stiff neck and confusion. He had recently received a kidney transplant 7 months ago, after which he had been giving immonosuppressive drugs to prevent organ rejection.

List three possible pathogens that could cause this disease

CSF was collected and revealed elevated glucose levels and WBC count. A gram stain prep of CSF was negative for organisms. Treatment with chloramphenicol and ampicillin was begun. The next day, cultures on blood plates grew small, round, smooth colonies surrounded by clear zones. What condition does the patient have?    What is your best guess to the causal agent? How would you continue treatment? Where did the patient likely get the infection?

Answer 1

Man has meningitis which can guess according to his symptoms. There are mainly three pathogens which can cause meningitis are as follow:

i)virus - Herpes simplex virus, HIV, mumps, west nile virus

ii) bacteria - streptococcus pneumoniae (most common)

iii) fungi - Cryptococcus neoformans, Cryptococcus gatti

It is mentioned that CSF prep gram stain was negative for organism but we have colonies on blood plate which eliminate viruses and bacteria. We left with fungus as causative agent. As C.neoformans and C.gatti are yeast so, they give smooth, round nd small colonies which relate with output of culture in question.

So the person has fungal meningitis, best guess for causative agent will be Cryptococcus neoformans.

It can be treated with combination of antifungal drug like amphotericin B and fluconazole.

Person got the disease by coming in contact of soil(inhalation of soil particles) which have been contaminated with bird fecal material. So it can happen while working in backyard garden or during travelling.