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
References
http://www.cdc.gov/ncidod/dvbid/westnile/surv&control.htm#surveillance
http://lifeinthefastlane.com/education/investigations-tests/csf-analysis/
