(e)This is a regimen for disseminated varicella or zoster—a herpes virus.
These lesions are vesicular in nature and usually become crusted.
189.The answer is d.(Tintinalli, p 570.)Spontaneous bacterial peritoni-
tis (SBP)is the most common complication of cirrhotic ascites and should be
suspected in all patients with a history of cirrhosis who present with fever,
abdominal pain or tenderness, worsening ascites, or encephalopathy.
Paracentesisshould be performed to confirm the diagnosis. Ascitic fluid
should be tested for glucose, total protein, lactate dehydrogenase (LDH), Gram
stain, and WBC count. Culture results are often negative; culture results’ yield
may be improved, however, by placing 10 mL of ascitic fluid in a blood culture
bottle. Total WBC count > 1000/μL or neutrophil count > 250/μL is diagnos-
tic for SBP. Gram-negative Enterobacteriaceae(eg,E coli, Klebsiella) account
for 63% of all cases. Empiric treatment for suspected SBP includes third-gen-
eration cephalosporins, ticarcillin clavulanic acid, piperacillin-tazobactam, or
ampicillin-sulbactam.
(a, b, c, and e)Other causes of SBP include S pneumoniaeandS viridans
(15%), enterococci (6%-10%), anaerobes (1%).
206 Emergency Medicine