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Old 10-20-2012
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Arrow Billy Step 1 Questions # 39

A 35-year-old man who received a kidney transplantation was being treated with cyclosporine, azathioprine, and high
doses of corticosteroids. While on this regimen, the patient began to experience headaches and became lethargic. A
clinical diagnosis of meningoencephalitis was made. He died 7 days later. Autopsy showed a gelatinous meningeal
exudate, and on sectioning of the brain, multiple, small cystlike areas were seen. Microscopic examination showed areas
containing rounded structures with a prominent capsule that stained brightly with mucicarmine. Which of the following tests
would have been most useful for diagnosis of this condition during life?


□ (A) Examination of CSF with an India ink preparation
□ (B) Determination of glucose and protein content of CSF
□ (C) Brain biopsy specimen stained for viral inclusions
□ (D) Culture of CSF for Streptococcus pneumoniae
□ (E) PCR assay to detect Epstein-Barr virus genome in lymphocytes isolated from CSF
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Old 10-20-2012
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will go with A) indian ink stain---cryptococcus neoformans

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Old 10-20-2012
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A) cryptococcus------ stains red with mucicarmine Source: FA
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(A) Examination of CSF with an India ink preparation
Cryptococcus- mucicarmine + ve
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One day i will infect these microbes and they will search for "Anti-MEbiotic"....
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Old 10-20-2012
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Correct Answer A is correct

The patient developed cryptococcal meningoencephalitis, a complication of his immunocompromised state.
Cryptococcus neoformans typically has a thick capsule, making it easily visible with the India ink preparation, a procedure
that can be performed within a few minutes. The glucose and protein levels of CSF can aid in determining whether an
infection is present, and what general type of organism is present, but they do not yield a specific cause. A cryptococcal
antigen test also would be useful for this patient. Brain biopsies are not commonly performed, and other, less invasive
methods should be pursued first. Bacterial meningitis is possible, and pneumococcus would be a common bacterial cause,
but this description is consistent with cryptococcosis. PCR probes for Epstein-Barr virus are not useful in this case
because acute viral meningitis usually does not cause a visible exudate, the onset of disease is more insidious, and it is
not typically associated with immunocompromised states.
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