Clinical Pearl

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    Clinical Pearl

    28 yo M with no pmh presents with HA, fever, and neck stiffness. He states that he recently came back from a week long business trip to Dallas. You get a CTH that is wnl and LP with results below.

    Pressure Normal

    Appearance Clear

    Protein < 1 g/L

    Glucose wnl

    Gm stain negative

    Lymphocyte predominance / pleocytosis

    What is the diagnosis? What pathogens should be considered? 

    A:

    VIRAL MENINGITIS – should consider West Nile Virus (WNV) as over 45% of all cases have been reported from Texas. Over 70 percent of the cases have been reported from six states (Texas, South Dakota, Mississippi, Oklahoma, Louisiana, and Michigan)

    Presents 3-14 days after mosquito bite

    Sx’s: high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness and paralysis

     

    CSF Analysis

     

     

     

    References

    http://www.uptodate.com/contents/image?imageKey=ID%2F76324&topicKey=PEDS%2F6028&rank=6~150&source=see_link&search=meningitis&utdPopup=true

    http://www.cdc.gov/ncidod/dvbid/westnile/surv&control.htm#surveillance

    http://lifeinthefastlane.com/education/investigations-tests/csf-analysis/

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