D.H., a 54-year-old resort owner, has had multiple chronic medical problems, inc

Question

D.H., a 54-year-old resort owner, has had multiple chronic medical problems, including type 2 diabetes mellitus (DM) for 25 years, which has progressed to his having been insulin dependent for the past 10 years: a kidney transplant 5 years ago with no signs of rejection at last biopsy: hypertension: and peptic ulcer disease. His medications include insulin, immunosuppressive agents, and two antihypertensive drugs. Three days ago he visited his local physician with complaints of left ear, mastoid, and sinus pain. He was diagnosed with sinusitis and Candida albicans infection (thrush): cephalexin (Keflex) and nystatin were prescribed. Later in the afternoon he developed nausea, hematemesis, and weakness and was taken to the emergency department. He was admitted and started on intravenous (IV) antibiotics, but his condition worsened throughout the night: his dyspnea increased and he developed difficulty speaking. He was flown the next morning to your tertiary referral center and was intubated en route. On arrival, D.H. had decreased level of consciousness with periods of total unresponsiveness, weakness, and cranial nerve deficits. His admitting diagnosis is meningitis. He has since developed aspiration pneumonia and atrial fibrillation. D.H. has continued fever and leukocytosis despite aggressive antibiotic therapy. 1. Why was D.H. at particular risk for infection? 2. Describe bacterial meningitis.

Explanation / Answer

1. D.H. was at an increased risk of infections as he was severely diabetic and on an immunosuppressant. Thus his body’s defense mechanism was suppressed.

2. Bacterial meningitis is an infection that affects the membranes (meninges) surrounding the brain and the spinal cord. Several strains of bacteria can cause acute bacterial meningitis, most commonly are; Streptococcus pneumonia, Neisseria meningitides, Haemophilus influenzae and Listeria monocytogenes. They can be treated with antibiotics.

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