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Ch. 18 - Nervous System Infections
Norman-McKay- Microbiology: Basic and Clinical Principles 2nd Edition
Norman-McKay2nd EditionMicrobiology: Basic and Clinical PrinciplesISBN: 9780137661619Not the one you use?Change textbook
Chapter 18, Problem 4

A patient under one year old is vomiting, drowsy, floppy (flaccid), and unresponsive. Both infant botulism and infant meningitis caused by other bacteria are suspected. Which piece of information would best help narrow down the possible diagnosis?
a. The child has spent almost no time outside the home.
b. The child is being breast-fed.
c. The child was born one month ago.
d. The child has a very high fever.

Verified step by step guidance
1
Step 1: Understand the clinical presentation. The infant is vomiting, drowsy, floppy (flaccid), and unresponsive, which are symptoms that can be seen in both infant botulism and bacterial meningitis.
Step 2: Recall key differences between infant botulism and bacterial meningitis. Infant botulism is caused by ingestion of Clostridium botulinum spores leading to neurotoxin production causing flaccid paralysis without fever. Bacterial meningitis typically presents with fever, irritability, and signs of infection.
Step 3: Analyze each option to see which clinical feature helps differentiate the two conditions. For example, fever is common in meningitis but usually absent in botulism.
Step 4: Identify that the presence or absence of fever (option d) is a critical clinical clue to distinguish between infant botulism and bacterial meningitis.
Step 5: Conclude that knowing whether the child has a very high fever would best help narrow down the diagnosis between these two conditions.

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Key Concepts

Here are the essential concepts you must grasp in order to answer the question correctly.

Infant Botulism Pathophysiology and Presentation

Infant botulism is caused by Clostridium botulinum spores colonizing the infant's gut, producing neurotoxins that cause flaccid paralysis. Symptoms include constipation, poor feeding, lethargy, and muscle weakness without fever. It typically affects infants under one year and is linked to environmental exposure to spores.
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Free Antigens vs. Presented Antigens on APCs

Clinical Features of Infant Meningitis

Infant meningitis is a bacterial infection of the meninges causing inflammation. It often presents with fever, irritability, vomiting, lethargy, and sometimes a bulging fontanelle. Fever is a key distinguishing symptom, as meningitis usually triggers a systemic inflammatory response.
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Features of Bacterial Cells

Diagnostic Importance of Fever in Differentiating Infections

Fever is a hallmark of systemic bacterial infections like meningitis but is typically absent in infant botulism. Identifying the presence or absence of fever helps clinicians differentiate between neurotoxin-mediated paralysis and infectious inflammation, guiding appropriate diagnosis and treatment.
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Related Practice
Textbook Question

During a lumbar puncture procedure, the nurse observed that the patient’s CSF pressure was high. However, when the analysis of the CSF sample comes back, the glucose levels are normal. The nurse would most likely suspect:

a. arboviral meningitis.

b. Neisseria meningitidis.

c. Listeria monocytogenes.

d. poliovirus.

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Textbook Question

A patient’s lab data report has come back with a positive ELISA for pneumococcal C polysaccharide from CSF samples. The MOST appropriate next step for a health professional to recommend is to

a. culture from the CSF sample to test for antibiotic resistance.

b. administer tetracycline.

c. administer cephalosporin.

d. wait for RT-PCR confirmation before antibiotic treatment.

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Textbook Question

A vaccine against Listeria monocytogenes is a challenge to develop because

a. very few people get Listeria meningitis.

b. the antibody-mediated immune response is not effective against L. monocytogenes.

c. better prevention approaches exist, such as food preparation precautions.

d. vaccinations are not used for foodborne illness.

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Textbook Question

CSF glucose levels are often assessed to differentiate between bacterial and viral meningitis. This is because

a. bacteria cells use glucose and lower the overall concentration in the CSF.

b. viral meningitis causes inflammation that blocks glucose transport into the CSF.

c. viral infection of the meninges causes cell lysis, releasing glucose into the CSF.

d. None of the above.

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Textbook Question

Viral meningitis is more common than other forms of meningitis because

a. these infectious agents are all intracellular, evading the immune system.

b. there are more types of viruses than bacteria because they evolve more quickly.

c. the small size of viruses makes them able to pass more easily through the blood–brain barrier.

d. viruses are spread person to person more easily than bacteria, fungi, or protozoans.

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Textbook Question

A patient is admitted who is complaining of headache, disorientation, and numbness in his left arm. He was bitten by a raccoon two days before. The FIRST step taken to help this patient would be

a. retrieving and testing the raccoon’s brain tissues for the rabies virus.

b. collecting a CSF sample from the patient.

c. performing a tissue biopsy on the patient to look for Negri bodies.

d. administering an anti-rabies vaccine as well as anti-rabies antibodies.

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