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Chapter 14. The Streptococci, Enterococci, and Related Genera

A 48-year-old alcoholic man is admitted to a hospital because of stupor. He is unkempt and homeless and lives in an encampment with other homeless people, who called the authorities when he could not be easily aroused. His temperature is 38.5°C, and his blood pressure 125/80 mm Hg. He moans when attempts are made to arouse him. He has positive Kernig and Brudzinski signs, suggesting meningeal irritation. Physical examination and chest radiography show evidence of left lower lobe lung consolidation. An endotracheal aspirate yields rust-colored sputum. Examination of a Gram-stained sputum smear shows numerous polymorphonuclear cells and numerous Gram-positive lancet-shaped diplococci. On lumbar puncture, the cerebrospinal fluid is cloudy and has a white blood cell count of 570/µL with 95% polymorphonuclear cells; Gram-stain shows numerous Gram-positive diplococci. Based on this information, the likely diagnosis is

(A) Pneumonia and meningitis caused by S. aureus

(B) Pneumonia and meningitis caused by S. pyogenes

(C) Pneumonia and meningitis caused by S. pneumoniae

(D) Pneumonia and meningitis caused by E. faecalis

(E) Pneumonia and meningitis caused by Neisseria meningitidis

A 48-year-old alcoholic man is admitted to a hospital because of stupor. He is unkempt and homeless and lives in an encampment with other homeless people, who called the authorities when he could not be easily aroused. His temperature is 38.5°C, and his blood pressure 125/80 mm Hg. He moans when attempts are made to arouse him. He has positive Kernig and Brudzinski signs, suggesting meningeal irritation. Physical examination and chest radiography show evidence of left lower lobe lung consolidation. An endotracheal aspirate yields rust-colored sputum. Examination of a Gram-stained sputum smear shows numerous polymorphonuclear cells and numerous Gram-positive lancet-shaped diplococci. On lumbar puncture, the cerebrospinal fluid is cloudy and has a white blood cell count of 570/µL with 95% polymorphonuclear cells; Gram-stain shows numerous Gram-positive diplococci.

The patient is started on antibiotic therapy to cover many possible microorganisms. Subsequently, culture of sputum and cerebrospinal fluid yields Gram-positive diplococci with a minimum inhibitory concentration to penicillin G of greater than 2 μg/mL. The drug of choice for this patient until further susceptibility testing can be done is

(A) Penicillin G

(B) Nafcillin

(C) Trimethoprim–sulfamethoxazole

(D) Gentamicin

(E) Vancomycin

A 48-year-old alcoholic man is admitted to a hospital because of stupor. He is unkempt and homeless and lives in an encampment with other homeless people, who called the authorities ...

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