Match each patient's clinical exposure scenario with the most appropriate post-exposure prophylaxis or management strategy.
- A 42-year-old camper who awakens to find a live bat inside his closed tent, though he has no visible bite or scratch marks on his skin.Rabies vaccine series and human rabies immune globulin
- A 20-year-old university student whose roommate was admitted to the intensive care unit yesterday with meningococcal meningitis.Single oral dose of ciprofloxacin
- A 30-year-old pregnant woman at 16 weeks gestation, who has a negative varicella IgG titer, following face-to-face exposure to a child with active chickenpox.Intramuscular varicella-zoster immune globulin
- A 34-year-old fully vaccinated healthy woman whose 3-month-old infant was just diagnosed with a Bordetella pertussis infection.Five-day course of oral azithromycin
Answer
The correct matches require aligning the specific pathogen exposure with its guideline-directed prophylaxis: the sleeping bat exposure warrants rabies vaccine and immune globulin; the meningococcal roommate contact requires a single dose of ciprofloxacin; the non-immune pregnant woman exposed to varicella requires varicella-zoster immune globulin; and the pertussis household contact requires oral azithromycin.
Each exposure scenario necessitates a specific immunologic or antimicrobial prophylactic intervention. Unrecognized bat exposures while sleeping warrant full rabies PEP due to the high fatality of the disease. Meningococcal close contacts need ciprofloxacin, ceftriaxone, or rifampin to clear colonization. Non-immune pregnant women exposed to varicella require passive immunization (VZIG) because the live vaccine is contraindicated. Finally, pertussis household contacts need macrolide prophylaxis irrespective of past vaccination status.
Step-by-Step Solution
Key Concept
Post-exposure prophylaxis protocols for highly communicable or fatal infectious diseases