Review Question - QID 102687

This patient is presenting with a fever, altered mental status, and a lumbar puncture with a Gram stain showing gram-negative diplococci, suggestive of Neisseria meningitidis. Antibiotic prophylaxis is indicated for meningococcal meningitis for those who have had close contact for 8 hours or those who have had direct exposure to respiratory secretions such as this patient's boyfriend who she lives with (thus, he should be treated with rifampin).

Meningitis is a potentially life-threatening condition and requires accurate diagnosis and treatment of the patient and close contacts. In adults, the most common bacterial etiologies of meningitis are S. pneumoniae and N. meningitidis. Meningococcal meningitis typically presents with fever, headache, neck stiffness, photophobia, altered mental status, and occasionally, a petechial rash. Workup includes lumbar puncture with Gram stain and culture. After a lumbar puncture is performed, healthy adults should be started on vancomycin, ceftriaxone, and dexamethasone empirically until culture results demonstrate the causative organism and its susceptibility. All close contacts or anyone with > 8 hours of contact with the patient or their respiratory secretions should receive prophylactic antibiotics with rifampin being the typical agent of choice.

Incorrect Answers:
Answer 1: Add ampicillin, dexamethasone, and rifampin to treatment regimen is incorrect because ampicillin would only be needed for an elderly patient for coverage of Listeria monocytogenes. Similarly, dexamethasone is not needed since Streptococcus pneumonia is not the causative organism. Finally, rifampin is indicated for contacts not the patient.

Answer 2: Add ampicillin to treatment regimen would be appropriate if this were an elderly patient to cover for Listeria monocytogenes.

Answer 3: Add dexamethasone to treatment regimen is not needed since the causative organism is likely not Streptococcus pneumonia given the Gram stain findings.

Answer 4: Treat boyfriend with ceftriaxone and vancomycin is incorrect as this is the full broad-spectrum coverage for bacterial meningitis with active disease. This is not indicated for prophylaxis.

Bullet Summary:
Close contacts of patients with meningitis should receive prophylaxis with rifampin.