A 32-year-old woman presents to the emergency department with a 3-day history of fever, severe frontal headache, and neck stiffness. She reports photophobia and has had one episode of emesis. Vital signs: temperature 39.4°C, heart rate 112 bpm, blood pressure 116/74 mmHg, respirations 20/min. On examination, she has a positive Kernig sign and Brudzinski sign. Lumbar puncture is performed emergently and reveals cloudy cerebrospinal fluid with the following values: WBC 1,200/μL (90% neutrophils), protein 185 mg/dL, glucose 18 mg/dL (serum glucose 98 mg/dL), Gram stain shows gram-negative diplococci. She denies recent travel, rash, or sick contacts. Which of the following is the most appropriate initial treatment regimen?
- A)Penicillin G intravenously
- B)Ceftriaxone and vancomycin intravenouslyGABARITO
- C)Ceftriaxone and fluoroquinolone
- D)Ampicillin, gentamicin, and cephalothin
- E)Chloramphenicol intravenously
Explicação
The clinical presentation is consistent with acute bacterial meningitis. Gram-negative diplococci in the CSF is characteristic of Neisseria meningitidis. The CSF parameters (elevated WBC with neutrophil predominance, elevated protein, decreased glucose with lo... Ver explicação completa e trilha adaptativa →