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Patient case: Acute Bacterial Meningitis

Patient case: Acute Bacterial Meningitis

Discussion

A 24-year-old university student is brought to the emergency department by his roommates after experiencing a sudden high fever, severe headache, and vomiting for the past 12 hours. He also complains of neck stiffness and sensitivity to light. His friends noticed that he became increasingly drowsy and confused over the past few hours.

On examination, his temperature is 39.2°C (102.6°F), blood pressure is 110/70 mmHg, heart rate is 112 beats per minute, and respiratory rate is 22 breaths per minute. He is lethargic but arousable. Neurological examination reveals a positive Brudzinski's sign and Kernig’s sign, along with neck rigidity. No focal neurological deficits are present.

A lumbar puncture is performed, showing cloudy cerebrospinal fluid (CSF) with an elevated white blood cell count, high protein, and low glucose levels. Gram stain reveals Gram-negative diplococci, confirming Neisseria meningitidis as the causative organism.

The patient is immediately started on intravenous ceftriaxone, dexamethasone, and supportive care. Close contacts are given prophylactic antibiotics to prevent further spread. After a week of intensive treatment, he recovers with no neurological complications.

Questions
1. What is the most likely diagnosis in this patient?

a) Viral meningitis

b) Acute bacterial meningitis

c) Encephalitis

d) Brain abscess

2. Which of the following cerebrospinal fluid (CSF) findings is most indicative of bacterial meningitis?

a) Clear CSF with normal glucose and protein levels

b) Cloudy CSF with high white blood cell count, low glucose, and high protein

c) Increased red blood cells in CSF with normal glucose

d) Normal CSF with mildly elevated white blood cells

3. What is the most appropriate immediate treatment for this patient?

a) Oral antibiotics and symptomatic care

b) Intravenous ceftriaxone and dexamethasone

c) High-dose corticosteroids alone

d) Supportive care with IV fluids only

4. Why are close contacts of the patient given prophylactic antibiotics?

a) To prevent secondary bacterial pneumonia

b) To prevent the spread of Neisseria meningitidis

c) To boost the patient’s immune response

d) To treat any undiagnosed viral infection

Reveal answers

Answers

1. Answer: b) Acute bacterial meningitis

The patient’s symptoms of fever, headache, vomiting, neck stiffness, and confusion, along with positive Brudzinski’s and Kernig’s signs, strongly indicate bacterial meningitis. The identification of Neisseria meningitidis in CSF confirms the diagnosis.

2. Answer: b) Cloudy CSF with high white blood cell count, low glucose, and high protein

Bacterial meningitis typically presents with cloudy CSF due to an elevated white blood cell count. Low glucose levels occur due to bacterial metabolism, and high protein is a result of inflammation.

3. Answer: b) Intravenous ceftriaxone and dexamethasone

Immediate IV antibiotics are critical for bacterial meningitis to reduce mortality. Dexamethasone is given to reduce inflammation and prevent complications such as hearing loss.

4. Answer: b) To prevent the spread of Neisseria meningitidis

Neisseria meningitidis is highly contagious, and close contacts are at risk of infection. Prophylactic antibiotics (e.g., rifampin or ciprofloxacin) help prevent outbreaks, especially in group settings like dormitories.