On Thursday in lecture we discussed CSF examination in Infectious Disease. Meningitis is characterized by inflammation of the membranes that cover the brain and spinal cord. It is divided into two categories: purulent and aseptic. Purulent meningitis is usually associated with bacterial infections and CSF examination revealing a large number of neutrophils. Aseptic meningitis is usually associated with viral infections and CSF examination revealing a large number of lymphocytes. The following table categorizes Purulent meningitis by age and condition and organisms commonly responsible for the infection.
| Age or Condition | Organism |
| Neonates | S. agalactiae E. Coli Listeria GNB
|
| < 5 | N. meningitidis S. pneumoniae H. Influenzae (hib) |
|
Young Adult
|
N. meningitidis |
|
Adult |
N. meningitidis S. pneumoniae
|
Elderly | S. pneumoniae Listeria S. aureus GNB
|
| Aids Patients | Cryptococcus neoformans |
Now we'll consider the following case history. See if you can identify the diagnosis and organism responsible for the infection in the following patient.
Case History:
A 38-year-old woman with no significant previous medical history came to the emergency department with a complaint of mild sore throat that had persisted for three days, accompanied by arthralgia, myalgia, and low-grade fever. The day before she had a severe headache with neck stiffness, nausea, and vomiting. Her white blood cell count was 21,800/mm3 with 67% polymorphonuclear leukocytes and 26% band cells. Platelet count was 200,000/mm3. Electrolyte levels were within normal range, and the glucose level was 131 mg/dL. A chest film showed no signs of pneumonia. A lumbar puncture revealed clear cerebrospinal fluid (CSF) with a glucose level of 88 mg/dL and a total protein level of 33 mg/dL and no cells. Approximately 12 hours later, she became acutely lethargic and a second spinal tap was performed. The CSF appeared cloudy and now contained 871 white blood cells, of which 93% were polymorphonuclear leukocytes; the glucose level was 1 mg/dL; the total protein level, 417 mg/dL. Gram stain revealed rare gram-negative diplococci.
In addition medium sized, smooth, gray to white colonies grew on chocolate agar. To discover the diagnosis and identification of the organism visit the following link...
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