D.H., a 54-year-old resort owner, has had multiple chronic medical problems, including type 2 diabetes mellitus (DM) for 25 years, which has progressed to insulin-dependent DM for the past 10 years; a kidney transplant 5 years ago with no signs of rejection at last biopsy; hypertension (HTN); and remote peptic ulcer disease (PUD). His medications include insulin, immunosuppressive agents, and two antihypertensive drugs. He visited his local physician with complaints of left ear, mastoid, and sinus pain. He was diagnosed with sinusitis and Candida albicans infection (thrush); cephalexin (Keflex) and nystatin were prescribed. Later that evening he developed nausea, hematemesis, and weakness and was taken to the emergency department. He was admitted and started on IV antibiotics, but his condition worsened throughout the night; his dyspnea increased and he developed difficulty speaking. He was flown to your tertiary referral center and was intubated en route. On arrival, D.H. had decreased level of consciousness (LOC) with periods of total unresponsiveness, weakness, and cranial nerve deficits. His diagnosis is meningitis complicated by an aspiration pneumonia and atrial fibrillation. D.H. has continued fever and leukocytosis despite aggressive antibiotic therapy.

What is the probable route of entry of bacteria into D.H.'s brain?

What happened with said patient was the face of the immunosuppressive treatment, the defense of the patient was decreased and it generated a worse picture with a bacterium that would not act in such a pathogenic way in another person who does not receive corticosteroid treatment.

This deduction could be made since prior to pneumonia and meningitis there were other infections that occurred in the patient indicating immunosuppression or lowered immunity, which were alerts for professionals.

Explanation:

The immunosuppression generated by corticosteroids is an adverse effect of said drug, thus causing bacteria or other pathogenic microorganisms to more easily generate lethal diseases that occur, similar to the human immuno-insufficiency syndrome.

These pneumonias and meningitis are very common in children but not in adults, which means that the defense of acquired immunity throughout life would not be serious.

In patients like these where corticosteroids suppress the path of humoral defense factors, thus inhibiting the presence of COX and thromboxane A2 in the immune lineage, that is why the immunological tests are weakened and the bacteria have more spread or harmful effects such as this patient.

The bacterium does not indicate that it is intra-surgical or hospital-based because of the severity of the disease it triggered, but because the patient is immunosuppressed.