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  #1  
Old 02-08-2011
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Arrow What treatment for this microscopic CSF Picture!

A 52-year-old Caucasian male treated for Hodgkin’s lymphoma presents to the ER with a two-week history of headaches and fever. Lumbar puncture shows a moderate increase in the CS protein concentration. Microscopic evaluation of his CSF reveals the following: The patient should be initially treated with:



A. Ceftriaxone
B. Ampicillin
C. Acyclovir
D. Amphotericin B
E. isoniazid
F. Pyrimethamine
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  #2  
Old 02-08-2011
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D. Amphotericin B - thinking this is cryptococcal infection.
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Old 02-08-2011
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D. Amphotericin B
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Old 02-08-2011
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Yep that's definately Cryptococcus Neoformans, anti fungal.. so Ampho B
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Old 02-08-2011
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This image shows the appearance of Cryptococcus neoformans with India ink staining. The thick polysaccharide capsule of this encapsulated yeast does not stain with India ink, and is seen as a peripheral clearing around the dark central part of the yeast. India ink staining of CSF is used for the diagnosis of cryptococcal meningitis.

DX
A latex particle agglutination test to detect cryptococcal capsular antigen in CSF can also be used to help make the diagnosis. Cryptococcal capsular antigen detection is more specific than India ink staining of CSF. Culture of the fungus on Sabouraudís agar is necessary to confirm the diagnosis.

PX
The typical presentation of cryptococcal meningitis is headache, fever and lethargy in an HIV (+) patient. Nausea, vomiting, stiff neck, and neurologic deficits may also be seen. The CSF changes in cryptococcal meningitis are similar to those seen in other fungal infections of the CNSI and include low glucose, increased protein, and increased cell count. Lymphocytes predominate, although some neutrophils may also be seen.

TX
Cryptococcal meningitis is treated with amphotericin B. Flucytosine is added in HIV (+) patients. HIV (-i-) patients also receive maintenance therapy with fluconazole for life.
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Old 02-08-2011
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Nice - super helpful to have the presentation and treatment with the explanation! It helps us review it all of a piece. Also, it seems that so many of the questions in the real test center on a description of presentation - so remembering the classical presentation is as helpful as remembering a picture... Keep up the good work! It's like visiting usmle-forums.com in "tutor mode"
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Thumbs Up Thanks Mondoshawan and aktorque

you both r doing excellent work..please keep posting these questions...thanks
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Microbiology-, Micrographs-, Nervous-System-, Step-1-Questions

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