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? 


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