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Difficulty: HardInfectious Diseases

Match each infectious exposure scenario with the most appropriate guideline-directed post-exposure prophylaxis or preemptive pharmacotherapy.

  • A 34-year-old healthcare worker sustains a deep hollow-bore needle-stick injury from a patient positive for HIV and Hepatitis B surface antigen. The worker has documented protective Hepatitis B surface antibodies from prior vaccination.A 28-day course of oral tenofovir-emtricitabine and raltegravir
  • A 26-year-old pregnant woman at 14 weeks gestation is identified as a close contact of a coworker who was recently hospitalized with confirmed meningococcal meningitis.A single dose of intramuscular ceftriaxone
  • A 50-year-old man who underwent a renal transplant six months ago has significant face-to-face exposure to a nephew with active varicella. The patient is seronegative for Varicella-Zoster virus IgG.Intramuscular administration of Varicella-Zoster immune globulin (VZIG)
  • A 22-year-old asymptomatic man presents to the clinic because his primary sexual partner developed a painless penile chancre 3 days ago. The patient's rapid plasma reagin (RPR) test is currently nonreactive.A single dose of intramuscular benzathine penicillin G

Answer

The healthcare worker requires HIV PEP (tenofovir-emtricitabine and raltegravir); the pregnant contact requires IM ceftriaxone; the transplant recipient requires VZIG; and the syphilis contact requires IM benzathine penicillin G.
Each scenario represents a specialized post-exposure prophylaxis protocol. Management must integrate the specific pathogen risks with critical host factors, such as established immunity, pregnancy, immunocompromised state, and the timing of exposure.

Step-by-Step Solution

1
Evaluate the healthcare worker's exposure to HIV and HBV.
Requires HIV PEP; protected against HBV.
Deep needle-sticks carry high HIV transmission risk requiring 3-drug PEP. Prior immunity to HBV (positive HBsAb) negates the need for HBIG or HBV vaccine boosters.
2
Assess the pregnant woman's exposure to N. meningitidis.
Requires prophylaxis with ceftriaxone.
Pregnancy restricts the use of standard PEP agents like ciprofloxacin or rifampin; ceftriaxone is the guideline-preferred safe alternative for meningococcal prophylaxis.
3
Analyze the transplant patient's exposure to varicella.
Requires Varicella-Zoster immune globulin (VZIG).
Immunocompromised hosts lacking VZV immunity are at extreme risk for life-threatening disseminated varicella and must receive passive immunization.
4
Determine the management for the syphilis contact with negative serology.
Requires empiric treatment with benzathine penicillin G.
Serologic tests (like RPR) may be falsely negative in incubating syphilis; high-risk exposure within 90 days warrants presumptive curative therapy.

Key Concept

Host-specific modifications of post-exposure prophylaxis and preemptive therapy for infectious diseases
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Topics

Infectious Diseases

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