A 21-Year-Old Man Is Brought to the Emergency Department by His

A 21-year-old man is brought to the emergency department by his roommate due to worsening fever, headache, and confusion.  The patient recently moved to a dormitory, and his prior medical problems and immunizations are unknown.  Temperature is 39.2 C (102.6 F) , blood pressure is 98/54 mm Hg, pulse is 112/min, and respirations are 24/min.  The patient appears acutely ill.  He is obtunded and has nuchal rigidity.  Leukocyte count is 19,000/mm³ with 20% band neutrophils.  Blood cultures are obtained and lumbar puncture is performed.  Gram stain of cerebrospinal fluid reveals gram-negative cocci in pairs.  Which of the following is the most likely way that this organism reached the meninges?

A) Middle ear → contiguous tissues → meninges
B) Pharynx → blood → choroid plexus → meninges
C) Pharynx → lymphatic system → meninges
D) Primary lung focus → blood → meninges
E) Traumatic wound → leaking cerebral spinal fluid → meninges

Correct Answer:

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