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Difficulty: MediumInfectious Diseases

Match each infectious disease clinical scenario with the most appropriate targeted antimicrobial therapy or post-exposure prophylaxis regimen.

  • A 21-year-old college student who shared a drink with a roommate 2 days prior to the roommate's admission for Neisseria meningitidis meningitis.Single-dose oral ciprofloxacin
  • A 30-year-old pregnant woman at 10 weeks gestation presenting with a targetoid rash on her thigh after a camping trip in a Lyme-endemic area.Oral amoxicillin for 14 days
  • A 45-year-old male presenting with a painless, 1-cm ulcer with raised, indurated borders on his glans penis and bilateral non-tender inguinal lymphadenopathy.Single-dose intramuscular penicillin G benzathine
  • A 28-year-old medical resident who sustained a deep percutaneous injury with a hollow-bore needle recently used on a patient with uncontrolled HIV.Oral tenofovir-emtricitabine plus dolutegravir for 28 days

Answer

Meningitis contact matches with single-dose ciprofloxacin; Pregnant patient with Lyme disease matches with amoxicillin; Primary syphilis matches with intramuscular penicillin G benzathine; HIV needle stick exposure matches with 28-day course of tenofovir-emtricitabine plus dolutegravir.
Each clinical scenario requires a specific, guideline-directed antimicrobial approach. Meningococcal close contacts need ciprofloxacin, rifampin, or ceftriaxone. Pregnant patients with Lyme disease should receive amoxicillin to avoid teratogenic effects. Primary syphilis is definitively treated with intramuscular penicillin G benzathine. High-risk occupational HIV exposures require a 28-day course of a 3-drug antiretroviral regimen.

Step-by-Step Solution

1
Evaluate the first scenario for meningococcal exposure prophylaxis.
Identify that sharing oral secretions with a meningococcal meningitis patient is a high-risk exposure requiring prophylaxis with ciprofloxacin, rifampin, or ceftriaxone.
Chemoprophylaxis prevents secondary cases among close contacts by rapidly eradicating nasopharyngeal carriage.
2
Assess the pregnant patient presenting with a targetoid rash.
Diagnose early localized Lyme disease (erythema migrans) and select amoxicillin.
Doxycycline is typically contraindicated in pregnancy due to fetal risks, making amoxicillin the first-line safe alternative.
3
Analyze the presentation of a painless penile ulcer.
Diagnose primary syphilis and select intramuscular penicillin G benzathine.
Penicillin remains the curative and definitive first-line treatment for early syphilis.
4
Evaluate the occupational HIV exposure risk.
Classify the hollow-bore needle stick from an uncontrolled HIV patient as high-risk, warranting full 3-drug post-exposure prophylaxis for 28 days.
A 3-drug regimen maximizes the prevention of viral integration and establishment of systemic infection after a significant exposure.

Key Concept

Appropriate selection of targeted antimicrobial therapy and prophylaxis depends on the specific pathogen, patient characteristics (e.g., pregnancy status), and the specific nature of the exposure.
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Topics

Infectious Diseases

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