A boy presented with a history of fever, headache and vomiting since 3 days and disorientation since I day. On examination, neck rigidity was positive. He also had 1 episode of generalized tonic clonic seizures (GTC) and then he became unconscious. CECT was found to be normal. CSF examination reveals a cell count of 300 cells/mm3 (polymorphs: 50-70%), protein 70 mg/dL, sugar 50 mg/dL (blood: 95 mg/dL). Which of the following is the most likely diagnosis?

Explanation

Ans. a. Pyogenic meningitis (ReJ: Harrison l9/e p887, 891, llll, l8/e p1029, 1692, 3414)The classic CSF abnormalities in bacterial meningitis are:Elevated opening pressure (> 180 mm H2O in 90%)Polymorphonuclear leakocytosis (>100 cells/ul in 90%)Decreased glucose concentration (<2.2 mmol/L or <40 mg/dl and or CSF/serum glucose ration <0.4 in 60%)Elevated protein concentration (>45 mg/dl)