[CSF Gram stain and AFB: neg, BS 178 mg% ]
เพิ่มเติม No immunocompromise, CSF OP 13.5 cmH2O, clea
วันนี้ [16-9-09] D/C แล้ว ไม่ไข้ ลุกเดินได้ ช่วยเหลือตัวเองได้ ฟอร์มปรอทเป็นดังนี้
Case นี้ยังเหลือผล H/C ถ้า negative คงจะช่วย confirm, review ดูพบว่า ส่วนใหญ่น้ำตาลใน CSF อาจปกติหรือต่ำลงได้เล็กน้อย
Aseptic meningitis
definition
is an illness characterized by serous inflammation of the linings of the brain (ie, meninges), usually with an accompanying mononuclear pleocytosis. Clinical symptomatology is varied and includes predominantly headache and fever. The illness is usually mild and runs its course without treatment; however, some cases can be severe and life threatening.
Aseptic meningitis syndrome is not caused by pyogenic bacteria, but can be caused by multiple conditions including infectious viral and nonviral causes and many noninfectious etiologies. Hence, this term is no longer synonymous with viral meningitis, although the two often are used interchangeably
Cause
1. Viruses
2.Bacteria: bacteria บางชนิดที่เป็นสาเหตุของ meningitis แต่ยากที่จะ identify ได้ เช่น syphilis, or tuberculosis, Lime disease
3.Other Conditions
-Fungi
-Certain noninfectious disorders
-Certain drugs, particularly drugs that affect the immune system
-Reactions to certain vaccines, such as those for pertussis (whooping cough) or rabies
-Injection of drugs or dyes (for treatment or diagnosis) in the subarachnoid space
Normal CSF P 9-18cm, WBC 0-5, Glu 50-75, Pr 15-40
ตอบลบคนนี้ไข้ + stiffneck +ve คิดว่าเป็น meningitis infection process
1. CSF pr ปกติ, glu 0.38 ต่ำไปนิด, Wbc 130 สูง
2. Mononeuclear cell คิดว่าเป็น Lymphocyte
3. Lymp + Glu ต่ำ Ddx TB, Fungus
plan
1. Anti HIV 2. india ink 3. Start CAT1
meningitis with lymphocyte predominate
ตอบลบViruses – most common cause :Enteroviruses 50-80% ,Arboviruses ,HIV-1 ,HSV-2, Mumps 10-20%
differential :
Mycobacteria
Listeria
Syphilis
Leptospira
Toxoplasma
Fungi – Cryptococcus
Meningeal carcinomatosis
Meningeal reaction to nearby inflammation, destructive process or medications
Reports estimate that 20-75% of patients with (viral meningitis have neutrophil predominance in the first CSF specimen obtained, especially in enterovirus, mumps and arbovirus infections
A repeat lumbar puncture in 8-12 hours frequently shows a change from neutrophil to lymphocyte predominance, with the remainder taking place in 24-48 hours )
from:www.med.unc.edu/medicine/web/meningitis.htm