A 19-year-old college student presents with severe frontal headache, neck stiffness, and altered mental status for 3 days. Vital signs show temperature 38.9°C, BP 118/76, HR 102, RR 18, SpO2 98% on room air. CSF analysis reveals lymphocytic pleocytosis (180 cells/μL), elevated protein (82 mg/dL), and normal glucose (58 mg/dL). Cryptococcal antigen and bacterial cultures are negative. No recent travel history is noted. Empiric acyclovir and ceftriaxone are initiated. Which organism should be included in the differential diagnosis?
- A)Histoplasma capsulatum meningitis
- B)Candida albicans meningitis
- C)Rhizopus meningitis
- D)Coccidioides immitis meningitisGABARITO
- E)Aspergillus fumigatus meningitis
Explicação
Coccidioides meningitis occurs in immunocompetent individuals, particularly in endemic areas (southwestern US). Presents with lymphocytic meningitis, elevated protein, normal glucose. Cryptococcal antigen negative helps distinguish from cryptococcal meningitis... Ver explicação completa e trilha adaptativa →