Chart-18

A 9-year-old child presented with fever, severe headache and vomiting.

O/E:  Child was found to be drowsy.

CSF analysis:

Appearance      - Turbid

Proteins           - 300 mg/dl (normal: 20-40 mg/dl)

Glucose           - 10 mg/dl (normal:  45-80 mg/dl)

Cell count        - 2000 cells/cumm

CSF SMEAR: 

A. Identify the predominant cell type.

Neutrophil

B. What is the diagnosis? Write two points in favour of your diagnosis. 

Pyogenic meningitis

1. Proteins elevated, glucose reduced, cell count markedly increased

2. Predominant cell type is neutrophil

C. Name any four causative organisms.

In infants – Stroptococcus pneumoniae, Haemophilus influenza, E. coli

In young adults – N. meningitidis

In elderly – S. pneumonia, Listeria monocytogenes

D. Mention any two contraindications for CSF aspiration. 

Raised intracranial pressure

Thrombocytopenia or other bleeding diathesis (including ongoing anticoagulant therapy)

Suspected spinal epidural abscess