A 68 year old women was admitted to a hospital because ofheadaches that began a month earlier. She was in good health, priorto developing severe headaches, vertigo, photophobia, lethargy, andforgetfulness. Her temperature was 98.9 degrees F, and she knew hername but not the date. She had some resistance to bending her neck,consistent with mild inflammation of the meninges. She also hadpast-pointing when reaching for objects. A lumbar puncture revealeda total white blood cell count of 18/microliter ( normal is up to4) and 75% polymorphonuclear leukocytes. CSF glucose was lowsuggesting a microbe was present in the subarachnoid space. The labtech performing the wbc count noticed cells that were not wbc. Toinvestigate further, the tech centrifuged the CSF, and stained thesediment with India ink. The round cell appeared to be budding,much like yeasts. In addition, the cell appeared to have acapsule.

1. What type of microbe could be causing the meningitis? Giveone reason to support your answer based on the informationprovided.

2. Of the following eukaryotic microbes, which one ischaracterized by having polysaccharide capsules? Candida albicans,Histoplasma capsulatum, Crytococcus neoformans.

In July of 2003 a construction worker came to a hospital in PalmBeach County complaining of fever, headaches, chills, nausea andmalaise. After being treated for dehydration he was discharged. Twodays later he returned to the hospital with worsening symptoms, andwas admitted with a diagnosis of malaria. The next day his bloodsmear revealed Plasmodium. During July and August a plumber whoworked outside, a fisherman who fished in the evenings, a golfer, ahomeless individual, a carpenter and an outdoorsman all hadPlasmodium infections. Six of the seven men had never traveled to amalarious region, none had had recent blood transfusions or was anIV drug user. Targeted mosquito trapping produced noPlasmodium-infected mosquitoes.

3. What could an epidemiologist infer from the interviews of theseven patients? What disease did all seven have?

4. How is this disease transmitted? How was it transmitted inthis case?