Question

Meningitis Case Study #3

Patient A: A 73-year-old Guatemalan man named Francisco Salazar was brought into the ER by his daughter with a chief complaint of a 5-day history of fever, back and neck pain, headache, and confusion. Francisco’s daughter notes that they live on a dairy farm and he has a history of cirrhosis and non-insulin dependent diabetes. A lumbar puncture was performed for cerebrospinal fluid (CSF) analysis.

Patient B: Alice Chen, a 6-year-old female, presented to the emergency department with a 4-day history of worsening headache and a rash on her trunk. Her mother mentioned that over-the-counter medications had no effect on her headache. Alice mentioned that the bright lights of the examination room hurt her eyes and she stated that her “head hurts all over.” She also had difficulty trying to move her neck. A physical test revealed some vesicular lesions on her hands and feet. A lumbar puncture was also performed for cerebrospinal fluid analysis.

	Normal CSF ranges	Patient #A	Patient #B
Leukocytes (per mm3)		1145	115
% Neutrophils		70	30
Glucose (mg/dL)		20	54
Protein (mg/dL)		410	53

Question 1: What type of meningitis do the patients have? What could be the pathogens?

Questions 2: What specific staining and cultures of your patients' CSF samples would help identify the pathogen, and why?

Question 3: What specific Serological or Biochemical Tests would be ordered to help identify the viral pathogens, and why?

Question 4: Final Report: Final Diagnosis, Treatment, and Prognisos for each patient.

Answer 1

1a high wbc count in csf especially neutrophils ,a low glucose level and a high protein level in csf indicates bacterial meningitis while in viral meningitis the glucose level is within normal range .normal range lie between 40 -80 mg/dl..csf protein level is elevated though they can be within the referance range . referance range is 20-50 mg/dl

while analysing the csf we can understand first patients diagnosis is bacterial meningitis and second one viral meningitis bacterial meningitis types

pneumococcal m.

meningococcalm.

listeria monocytogenes

neonatal m.

haemophilus m .

viral meningitis types

coxasachie or echovirus group

herpes

mumps and measles

2 gram staining of the csf permits rapid identification of bacterial cause in patients with bacterial meningitis. csf gram stain negative for viral meningitis and positive for bacterial meningitis besides this specific pathogen demonstrated in 60 % cases . real time pcr test for presence of genes specific for streptococcus pneumonia ,haemophilus influenza and neisseria menigitis

3 routene chemistry and serological test

in neonatal cases arterial blood gas analysis ,coagulation study and liver function test

pcr is the gold standard test for viral infection of cns . it is highly specific and sensitive test in adition to being fast and less invasive

4 in second case the viral meningitis is likely to be caused by herpes zoaster virus in which the lesion first appears on trunk and then centripetally distributed . the best way to prevent it is chickenpox vaccination

antiviral acyclovir is used to treat it

pneumococcal meningitis is most common type meningitis found in cirrhosis patients treatment options are vancomycin , ampicillin , cefotaxime penicillin .in serious form 1 in 5 people die 25 to 50 % survive with long term brain problems