Meningitis and brain abscess Quiz: Ace Your Exams
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A 53-year-old man presents to the emergency department for evaluation of headache. For the past two weeks, the patient has experienced a gradually intensifying, constant headache with associated light sensitivity and neck stiffness. The patient has a medical history significant for HIV, and he has been non-adherent with antiretroviral agents. On review of systems, the patient has had intermittent fever and cough. The patient does not currently take any medications. Temperature is 39.0°C (102.2°F), pulse is 110/min, respirations are 22/min, and blood pressure is 130/85 mmHg. On physical examination, the patient is squinting and resisting passive movement of the neck. With forward flexion of the neck, the hips flex bilaterally. A lumbar puncture is performed; results are shown below. Which of the following is the most likely causative organism in this patient’s condition?
| Cerebrospinal fluid (CSF) analysis | Result |
| Appearance | Clear |
| Glucose | 60 mg/dL |
| Protein | 70 mg/dL |
| White blood cell count | 450/microL |
| Red blood cell count | 0/microL |
| Opening pressure | 30 cmH2O |
| India ink stain | Positive |
| Acid-fast stain | Negative |
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