Diagnosis
The diagnostic test result most useful for differentiating a viral from bacterial etiology in a patient with acute meningitis.
What is a CSF showing a WBC with mostly lymphocytes?
The empiric treatment for bacterial meningitis infection in patients younger than 50.
What is vancomysin and a third-generation cephalosporin (ceftriaxone)?
The causative agent for subacute sclerosing panencephalitis.
What is measles?
The likely PMN count seen on the spinal tap of a 12-year-old boy admitted with high grade fever, projectile vomiting and neck stiffness and rigidity likely due to an acute bacterial meningitis.
What is 0 – 5 cells/µL?
Classically seen with multiple ring-enhancing lesions, and can cause deafness.
What is toxoplasmosis?
A contraindication for a spinal tap.
What is a patient with an intracranial or spinal mass lesion?
Treatment for HSV encephalitis as well as other viral meningitides.
What is acyclovir?
Pathogenesis described as the reactivation of virus in cranial nerve ganglia and retrograde spread along axons; Focal involvement of temporal lobe; Personality changes, obtundation, seizures, focal neurologic findings
What is HSV encephalitis?
The gram stain for the bacteria infecting a 57-year-old man from Pennsylvania coming to the ER with a 2-day history of fever, headache, and mental confusion, with nuchal rigidity, CSF showing 450 WBCs per mm3 (96% polymorphonuclears), and glucose at 32 mg/dL.
What is gram-positive?
CSF finding for a 29-year-old patient presenting with intractable headache and mild neck stiffness with a brain CT showing hydrocephalus and multiple intraparenchymal and intraventricular cysticercal lesions.
What is eosinophilic meningitis (increased eosinophils) associated with Taenia solium?
The eye exam finding (regarding the pupils) for a 56-year-old male who developed an STD 20 years ago now presenting with neurological problems including cognitive and visual problems.
What is to not react to light and accommodate?
The two vaccines that could prevent the potential infections affecting a febrile 15-month-old boy with nuchal rigidity that has been crying and vomiting.
CSF: 250 WBCs per mm3 (mostly PMNs), elevated protein, and decreased glucose.
What are the Haemophilus influenzae type b and Streptococcus pneumoniae protein conjugate vaccines?
Infectious agent in 32-year-old woman who is lucid, yet has had complaints for headache, malaise, paresthesias in hand from dog bite for 2 days, and who her boyfriend said had intermittent periods of extreme agitation and aggressive behavior for 1 day.
What is rabies?
The most likely diagnosis for a 44-year-old homeless male alcoholic in Miami brought to the ER by a friend because he was not eating much for a month and was “acting strange.”
Patient was febrile, emaciated, lethargic, and disoriented.
CSF: 620 WBCs per mm3 (all mononuclear), glucose of 24 mg/dL, and the Gram stain and fluorochrome stains revealed no organisms.
What is Tuberculosis?
The most likely organism responsible for infecting a 44-year-old male suffering from AIDS who dies after an attack of meningo-encephalitis, with an autopsy showing soap-bubble lesions that are visible with India-ink preparation.
What is Cryptococcus?
Infectious agent causing encephalitis typically in elderly patients with cranial nerve involvement, borderline fever and on MRI multiple cerebral infarcts and marked arterial narrowing are seen
What is varicella zoster virus?
Prophylaxis for listeria monocytogenes.
What is rifampin, ciprofloxacin, or ceftriaxone?
Common cause of aseptic meningitis that presents as hand, foot, and mouth disease.
What is Coxsackievirus?
The most likely cause of meningitis in a 30-year-old man in upper state New York with fever, facial nerve palsy, and spinal fluid with elevated lymphocytes, elevated protein, and normal glucose.
What is Borrelia burgdorferi?
The causative agent for a 27-year-old truck driver in Arizona brought to the ED with a 1-month history of headache, fever, and altered mental status, and a lumbar puncture and CSF analysis showing an increased opening pressure, increased WBC count with a predominance of lymphocytes, increased protein, and decreased glucose.
What is Coccidioidomycosis?
Small Gram-positive rod, Facultative anaerobe, Motile, Beta-hemolytic
What is Listeria monocytogenes?
First line therapy for Lyme disease.
What is doxycycline?
Causative agent that presents with asymmetric weakness, hypotonia, flaccid paralysis, muscle atrophy, and malaise, with CSF: increased WBC, slight increase in protein, and no change in glucose.
What is poliovirus?
The most likely causative agent infecting a 35-year-old woman (PMH: cadaveric renal transplantation 10 months ago) hospitalized because of fever, headache, and confusion of 24 hours’ duration.
She attended a party three weeks ago where she ate processed meats and a variety of cheeses. She's currently on prednisone and azathioprine.
CSF: leukocyte count is 1,500 WBCs per mm3 (mostly PMNs), glucose is decreased, and protein is increased. The isolate grew best at 4 degrees C.
What is listeria monocytogenes?
The most likely disease affecting a 49-year-old female physician with a 2-month history of increasing forgetfulness, difficulty reading, loss of interest in her appearance, and walking with a jerky, wide-based gait, bilateral horizontal nystagmus and decreased visual acuity.
Only abnormal CSF finding is protein of 98 mg/dL.
Prion disease (Creutzfeldt-Jakob disease, with elevated amounts of 14-3-3 proteins) (would see spongiform encephalopathy)