An 8-Year-Old Girl Is Brought to the Emergency Department with Lethargy

question 100

Multiple Choice

An 8-year-old girl is brought to the emergency department with lethargy and fever.  The patient has had intermittent cough, fever, and headache for the past 3 weeks.  She vomited before dinner last night and went to bed early.  This morning, her father could not wake her up.  The patient is otherwise healthy.  She traveled with her family to rural Ecuador 2 months ago for a mission trip.  She has no other recent travel and no known sick contacts.  Temperature is 39.8 C (103.6 F) .  The patient is minimally responsive on examination.  Funduscopy shows papilledema, and chest auscultation reveals decreased breath sounds and crackles over the right middle lobe.  The results of lumbar puncture are as follows: Which of the following organisms is the most likely cause of this patient's symptoms?

• A)Aspergillus fumigatus
• B)Enterovirus
• C)Listeria monocytogenes
• D)Mycobacterium tuberculosis
• E)Streptococcus pneumoniae
• F)Toxoplasma gondii