Question

A 15-year old boy complains of headache, dizziness, nausea, and feeling very weak. The following day he experiences an increase in body temperature, an increase in the severity of his headache, and the development of a rash, whereupon he is taken to hospital. Upon examination by the physician, it is noted that the patient has a temperature of 103.5 F and an increased heart rate. The doctor also notices some stiffness in his neck, as the boyis unable to bring his chin to the chest when asked to bend his head forward. The boy requests the attending nurse to draw the curtains as he feels uncomfortable with the light coming into the room. Additionally, the doctor notices rashes on the boy’s extremities and wrists. With a provisional diagnosis of meningitis, the physician orders for a complete blood count (CBC), blood for culture and lumbar puncture (LP) for CSF examination. The LP examination included tests for the presence of bacteria (Gram stain), cell count and differential, glucose and protein. A culture of the fluid is also done to detect the type of bacteria, if any, that may be present. In addition,Radiology is called to perform a CT scan of the brain on the patient.

Once the blood and the CSF analysis reports come in (see below), the patient is admitted to the critical care unit of the hospital and the treatment is begun for bacterial meningitis.

What clinical finding(s) helped the physician to provisionally diagnose 'meningitis'?

What stands out most in your opinion, in the blood and CSF analysis report?

What would be the best treatment plan for this patient?

Why did those rashes appear and what is its significance?

Why was the CT Scan ordered by the physician?
Relevant CBC Results (Abnormal Results Highlighted in Red) CBC Value Patient Normal Value 5000 10,000 White Blood Cell 24.000 mm3 Neutrophies 37% Spinal Fluid Analysis Abnormal Results Highlighted in Red) Test Parameter Patient Normal Values Hazy Appearance Clear 16 mg dl 50-80 mg/dl Glucose 15-45 mg/dl Total Protein 88 mg/dl White Blood Cells 2300 mm3 0-3 mm3 0-1 Cell Differential 96% neutrophiles neutrophiles Stain (see and should be results) gram negative CSF present. diplococci s a sterile fluid 140 mm/H20 Intracranial 174 mm/H20

Answer 1

1. The presence of bacteria in CSF using Gram's stain helped the physician decide that it may be meningitis.

2. The blood and CSF report clearly suggest that there is a lot of inflammation due to the bacteria by viewing the white blood cell and neutrophil counts.

3. Initially the patient can be given antibitic to bring down the inflammation and also fight with the bacterial infection. The next step would be to heal the brain hemorrhage.

4. The rashes were due to the bacterial infection and this may be due to the excessive inflammation by the body against the bacteria.

5. The CT scan ordered by the doctor to see the hemorrhage in the brain and also get a sense how bad is the blood leak due to which there was a bacterial infection in the CNS which otherwise is a secluded place barring all the foreign antigens.