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Old 03-30-2010
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Question Sickle Child with Nuchal Rigidity?

A 3 year old Sickle cell disease child brought by his mother because he developed a very high fever for the last 4 hours. Before this he was healthy and had no problems and vaccinated up to date. On examination the physician noted nuchal rigidity. Which of the following organisms would most likely be found in the CSF?

A- Streptococcus pneumonia
B- Listeria monocytogenous
C- Group B Streptococcus
D- Group A beta hemolytic streptococci
E- E coli
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Old 03-30-2010
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I think its strep pneumonia ......
1. as most common cause of meningitis in all age group except neonatal period ...
2. As sickle cell patient has autoinfarct of spleen cant destroy encap organism like this ....
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Old 03-30-2010
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The distractor in this question is the vaccination status of the boy. Despite being vaccinated, he still is susceptible to infections by encapsulated bacteria (such as Streptococcus pneumoniae), given his functional asplenia due to sickle cell disease. Thus the correct answer is A.

Listeria monocytogenous affects the newborns & the elderly, GBS & E. coli affect the newborns (choices B, C & E are not correct).

GAS is not known to cause meningitis (choice D is not correct).
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Old 03-30-2010
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Warning! This question is old

I think this is an outdated question because the current routine vaccination of all children with the pentavalent pneumococcal vaccine has prevented over 95% of invasive pneumococcal disease (including meningitis) even in susceptible populations (such as this Sickler).

The CSF nowadays in such a scenario will likely to show viral etiology
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