List the most likely pathogens which may be encountered in patients admitted with severe sepsis in the following clinical circumstances.
|
Clinical circumstance |
Pathogen |
|
Encephalitis following a flying fox bite |
|
|
Gram negative sepsis in a patient recently returned from Papua New Guinea during the wet season |
|
|
Gram negative sepsis in a patient who has been on meropenem for a week |
|
|
Meningitis in a post splenectomy patient |
|
Clinical circumstance |
Pathogen |
|
Encephalitis following a flying fox bite |
Lyssa virus or rabies virus or rhabdo virus |
|
Gram negative sepsis in a patient recently returned from Papua New Guinea during the wet season |
Melioidosis / Acinetobacter |
|
Gram negative sepsis in a patient who has been on meropenem for a week |
Stenotrophomonas or multi- resistant pseudomonas or acinetobacter |
|
Meningitis in a post splenectomy patient |
Pneumo or meningococcus, |
This is another game of "Name That Microbe".
Flying foxes carry Lyssavirus, which resembles rabies and can completely destroy your brain.
It takes little imagination to surmise that PNG during the rainy season is not exactly a sterile place to be. However, I shamefully confess I had no idea what the endemic gram-negatives look like. Fortunately, a Google Scholar search for the string "papua new guinea gram negative rainy season" yielded this article on melioidosis as the first result. In short, it is a dangerous predominantly pulmonary infection by Burkholderia pseudomallei.
The patient who has been marinading in meropenem will likely have an ESBL meropenem-resistant gram negative bug - probably something from the Enterobacteriaceae family. Potential candidates include Enterobacter, Stenotrophomonas, Citrobacter, Acinetobacter, Serratia, Achromobacter and so on and so forth.
Meningitis in the asplenic person is likely due to an encapsulated organism - and statistially speaking, this is most likely going to be S. pneumoniae, although N.meningitides or H.influenzae are also potential culprits.
Fraser, Graeme C., et al. "Encephalitis caused by a Lyssavirus in fruit bats in Australia." Emerging infectious diseases 2.4 (1996): 327.
Currie, Bart J., et al. "The epidemiology of melioidosis in Australia and Papua New Guinea." Acta tropica 74.2 (2000): 121-127.