Correct!
5. All of the above
Given the clinical situation and the abnormal CSF findings, meningitis is a possibility. Empiric antibiotic treatment is indicated pending the results of cultures. He was administered ceftriazone 2gm every 12 hours, vancomycin 15mg/kg every 12 hours (empirical treatment for bacterial meningitis), ampicillin 4 million units every 6 hrs (to cover Listeria meningitis since he was > 60 years of age) and acyclovir 10mg/kg every 6 hours (to cover Herpes simplex encephalitis).
Over the next 48 hours, the patient had recurrent fevers and chills and intermittently became agitated and confused. Progressive lethargy intervened, and he was intubated for airway protection. Bacterial blood cultures and CSF culture were negative. CSF Herpes simplex virus polymerase chain reaction (PCR), and coccidioidomycosis complement fixation were negative, as were serological tests for enterovirus, Western and Eastern equine, St. Louis and California encephalitis viruses.
Which of the following is the most likely cause of the patient’s clinical picture?