Clinical Mycology Course Posttest

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Clinical Mycology Course Posttest

To obtain your certificate from ISHAM for completing this Clinical Mycology Course, you will need to successfully complete this posttest and fill out the evaluation. A score of 75 or greater is required on the posttest.

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Basilar Meningitis Case

A 37-year-old woman from the Southeast United States presents with evidence of rejection of a 4-year-old kidney transplant and is treated with methylprednisolone and OKT3. She has not traveled recently. Approximately 3 months later, while on immunosuppressive agents, she presents to the emergency department with a 2-week headache and severe nausea. Her temperature is normal. She has bilateral clonus and papilledema but a normal mental status examination. An MRI scan shows mild leptomeningeal enhancement, consistent with a basilar meningitis. CBC count is normal; creatinine level is 3.5 mg/dL.

Initial lumbar puncture results are:

WBCs 97 nucleated cells per cubic millimeter
Glucose 43 mg/dL (blood glucose level 110 mg/dL)
Protein 80 mg/dL
Opening pressure was 360 mm of CSF

Question 1. What is at the top of your differential diagnosis?

4 points

Coccidioidal meningitis

Pneumococcal meningitis

Listeria meningitis

Cryptococcal meningitis

Question 2. The patient is diagnosed with cryptococcal meningitis via multiple methods, and the culture grows out Cryptococcus neoformans. What is the next step in management?

4 points

Stop all immunosuppressive agents immediately

Manage the increased intracranial pressure

Begin high-dose fluconazole therapy

Begin single-dose liposomal amphotericin B 10 mg/kg x 1 plus oral flucytosine for 14 days

Question 3. Which of the following is true regarding cryptococcal infections in transplant patients?

4 points

Infections are more common in hematopoietic stem cell transplant patients vs kidney transplant patients

Only a minority of disseminated cases have positive blood cultures or occur with concurrent cryptococcemia

Mortality rates in resource-limited settings are in the 10-15% range

Infections generally occur earlier in kidney transplants vs liver and lung transplants

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