Question of the Week # 6

A 24 y/o college freshman who lives in a dormitory brought to the ER with complaints of fever, headache and neck stiffness. Lumbar puncture revealed gram negative diplococci. He was started on ceftriaxone and vancomycin. However, over the next two hours he develops complicated disease with renal failure and purpura. He becomes comatose and was intubated by the anesthetist for airway protection. After knowing that the patient likely has a meningococcal disease, the ER staff, the anesthetist and the residents who initially cared for the patient are very concerned and requests chemoprophylaxis. What is the most appropriate course of action?

A. Give Rifampin to the resident who collected blood from the patient

B.  Give Rifampin to the anesthetist

C. Give Ceftriaxone to the Nurse who took care of the patient

D. Give Rifampin to the ER physician who initially evaluated the patient

E. Give Rifampin to all those who took care of the patient.

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26 Responses

  1. B

    • b

  2. E??

  3. rifampin to the anesthesiologyst who perform the intubation, it has more
    risk from the exposition

  4. b

  5. E)

  6. eee

  7. B

  8. B.

    Health care worker with prolonged contact and exposed to the pt. respiratory secretions should have antibiotic prophylaxis

  9. Dr. Red,

    Would you confirm the answer for us please? I too think its B.

  10. B…because the meningocci are transmitted through oral and respiratory secreions..

  11. E

  12. I too think its B .

  13. BB

  14. I think now its B
    Dr Red, would you please confirm the answer?

    • b

  15. E
    Dr. Red…
    are you there?

  16. B is the answer

  17. I think E is the correct answer

  18. B POOR ANESTHETIST

  19. E

  20. B is the answer

    Household contacts of patients with meningococcal
    disease have an attack rate of 4 cases per 1000, which is 500 to 800 times greater than the general popula-tion.
    Antimicrobial chemoprophylaxis is recom-mended for close contacts (household members, day care center contacts, and anyone directly exposed to the patient’s oral secretions). Antimicrobial chemo-prophylaxis ideally should be started within the first 24 hours after the initial case is diagnosed, with prophylaxis starting greater than 14 days after contact offering little benefit.

    Household contacts – includes recent visitors who have stayed overnight in the 7 days preceding the case’s illness; those who share the same dormitory, military barracks, hostel bunkroom. Should receive clearance antibiotics and vaccination.
    2)
    Sexual contacts – sexual partner(s) of case + intimate kissing partners. Should be treated as household contacts and receive clearance antibiotics and vaccination.
    3)
    Travel contacts – seated immediately adjacent to a case on flight > 8 hours in duration. Should receive clearance antibiotics.
    4)
    Childcare contacts – children and staff in same room group at a child-care facility attended by index case for one period of ≥ 4 hours in 7 days preceding onset of case’s illness require clearance antibiotics.
    5)
    School and University contacts – depending of the nature of the contact and whether it occurred in relation to a specific outbreak (eg. related to a particular class) then clearance antibiotics may be appropriate.
    6)
    Health care worker contacts – only medical personnel who are directly exposed to a case’s nasopharyngeal secretions (ie: person who intubated case if facemask)

    Rifampin 600 mg taken orally twice a day for two days is the recommended antibiotic for chemoprophy-laxis,
    but should not be used in pregnant women due to its teratogenic effects. Other alternatives include
    ciprofloxacin 500 mg orally, or ceftriaxone 250 mg intramuscularly.

  21. Hello all!
    In some cases you mentioned duration of exposure and in others not should the minimum time for exposure be considered 4 hours to be safe ?

  22. What about the MD who did the LP?

  23. It is essential to be extremely selective when it comes to use of antibiotics for prophylaxis. Development of drug resistance is counterproductive. Antibiotic Stewardship is the current trend and recommendation of both CDC and Infectious Disease Society of America.
    Probability of transmission is higher in those exposed to infected respiratory secretions.
    In the list of options, we don’t know if any of the listed health worker was engaged in mouth to mouth respiration or airway suctioning but we know that the anesthetist intubated this patient. From the evidence presented in this question it is most appropriate to start prophylaxis in the anesthetist.
    My answer is Option B.

  24. Why coombs test is negative !! In autoimmjnhemolytic anemia must be positive

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