🧠🌀🦠💉🔬💊 NEUROSYPHILIS

A 46‑year‑old man with untreated HIV infection (CD4 = 180 cells/µL, HIV RNA = 75 000 copies/mL) is brought to the emergency department because of progressive memory loss, gait unsteadiness, and bilateral lower‑limb weakness over two months. He reports intermittent headaches and blurred vision.

• Vitals: T 37.4 °C, BP 126/72 mm Hg, HR 88 bpm.

• Neuro exam: wide‑based gait, positive Romberg, brisk patellar reflexes; pupils accommodate but are sluggish to light.

• Serum RPR: reactive 1 : 128 (prior documentation six months ago: non‑reactive).

• CSF: WBC 95 cells/µL (90 % lymphs), protein 110 mg/dL, VDRL reactive 1 : 16.

Question
Which antibiotic regimen is most appropriate to treat this patient’s infection?

A) Aqueous crystalline penicillin G 3 million units IV every 4 h for 14 days
B) Meropenem 2 g IV every 8 h for 14 days
C) Doxycycline 200 mg orally twice daily for 28 days
D) Ceftriaxone 2 g IV once daily for 14 days
E) Levofloxacin 750 mg IV once daily for 14 days

🫀🦠 MSSA Endocarditis

A 48‑year‑old man with poorly controlled type 2 diabetes and a history of intravenous heroin use presents with three days of fever, rigors, and pleuritic chest pain.

• Vitals: T 39.2 °C, HR 110 bpm, BP 118/66 mm Hg
• Exam: new holosystolic murmur at the left lower sternal border; several Janeway lesions on the palms; no focal neurological deficits.
• Investigations: Three blood‑culture sets grow methicillin‑susceptible Staphylococcus aureus (MSSA) within ten hours (oxacillin MIC ≤ 2 µg/mL). Transthoracic echo shows a 1.2 cm vegetation on the tricuspid valve with mild regurgitation. Renal and liver function are normal.
He has no β‑lactam allergy.

QUESTION
Which intravenous antibiotic regimen is most appropriate to start—and continue—for this infection?

A) Cefazolin 2 g IV every 8 h for at least six weeks
B) Vancomycin dosed to trough 15–20 mg/L for at least six weeks
C) Daptomycin 10 mg/kg IV once daily for at least six weeks
D) Linezolid 600 mg IV every 12 h for at least six weeks
E) Gentamicin 3 mg/kg IV once daily plus rifampicin 300 mg orally every 8 h

🦶🦠Diabetic foot infection

A 62‑year‑old man with poorly‑controlled type 2 diabetes (HbA1c 9.4 %) is admitted with a worsening plantar ulcer under the right first metatarsal head.

Two weeks ago his podiatrist prescribed trimethoprim–sulfamethoxazole (TMP‑SMX) for presumed mild cellulitis. The ulcer has enlarged, now draining malodorous pus.

Vitals: T 38.3 °C, HR 96 bpm, BP 132/78 mm Hg.
Exam: 3 × 2 cm ulcer, erythema extending 4 cm, no bone palpated. Peripheral pulses intact.
Labs: WBC 13 000/µL (85 % neutrophils), CRP 110 mg/L, Cr 1.0 mg/dL.
X‑ray: soft‑tissue swelling; no osteitis.

You plan empiric IV therapy while awaiting deep‑tissue culture.

Which regimen is most appropriate now?

A. Continue TMP‑SMX and add oral clindamycin
B. Vancomycin plus cefepime
C. Piperacillin–tazobactam (Zosyn)
D. Linezolid monotherapy
E. Ciprofloxacin plus metronidazole