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/