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CASE BASED LEARNING On Meningitis and Encephalitis

The document presents a series of clinical cases related to meningitis and encephalitis, detailing patient symptoms, laboratory findings, and required investigations. Each case prompts the reader to identify pathogens, suggest treatments, and interpret diagnostic results. The cases cover a range of ages and conditions, emphasizing the importance of microbiological analysis and clinical diagnosis in managing these neurological infections.

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Ananya Seth
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53 views16 pages

CASE BASED LEARNING On Meningitis and Encephalitis

The document presents a series of clinical cases related to meningitis and encephalitis, detailing patient symptoms, laboratory findings, and required investigations. Each case prompts the reader to identify pathogens, suggest treatments, and interpret diagnostic results. The cases cover a range of ages and conditions, emphasizing the importance of microbiological analysis and clinical diagnosis in managing these neurological infections.

Uploaded by

Ananya Seth
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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CASE BASED LEARNING

MENINGITIS AND ENCEPHALITIS


CASE 1
• 1. A 20 year old woman with the sudden onset
of fever to 104C and a severe headache. Physical
examination reveals nuchal rigidity.
• A) Name the specimen you would like to collect.
• B ) how this specimen would be transported to
lab.
• C) Name the Microbiological investigations
investigations that should be done with the
sample collected.
D) Interpret the following test result:
Cytology of the CSF reveals:
• TLC =337 CELLS/mm3
• Neutrophils: 89%
• Lymphocytes: 9%
• Monocytes: 2%
• Eosinophils: NIL

BIOCHEMICAL ANALYSIS OF CSF


• CSf glucose 10 mg/dl
• CSf protein= 280 mg/dl
E) Grams staining showed gram positive cocci,
lanceolate shaped, surrounded by a capsule.

1)Identify the pathogen, and suggest suitable


Antibiotic t/t.
CASE 2:
• A 54 year old pigeon breeder presented himself to the hospital with
complains of headache, nausea, vomiting for the past one month. He also
had blurred vision and confusion .

• He was not febrile.

• The attendant also described agitation, depression and other behavioral


changes in him recently.

• On laboratory testing, it was revealed ,that he is HIV positive.


• CSF examination , India ink preparation ,revealed BYLC with clear refractile
spaces around them.
•
• 1.what is the clinical diagnosis.
• 2.Identify the etilogical agent on the basis of test done.
• 3. Any other test would that can be done to assist in the diagnosis.
• 4. suggest the suitable Ab regime in this case.
CASE 3:
• A 5 Year old girl was admitted to the hospital with complaints of high grade
fever ,headache, vomiting ,altered mental status, seizure and neck rigidity.
• CSF sample was collected by lumbar puncture in a sterile container and sent
to the laboratory for Gram staining.
Biochemical analysis of CSF revealed
• CSF opening pressure as 200mm of water.
• Csf protein =260mg/dl
• Csf glucose =20mg/dl

Cytological analysis of CSF revealed the TLC=2000/mm3,predominantly


neutrophilic
• Gram stain of heaped smear of CSF showed gram negative diplococci ,lens
shaped.
• 1.what is your clinical diagnosis.
• 2. what could be the probable etiological agent.
• 3.what is the preferred treatment of choice in this case.
• Gram stain of heaped smear of CSF showed
gram negative diplococci ,lens shaped.

• 1.what is your clinical diagnosis.


• 2. what could be the probable etiological agent.
• 3.what is the preferred treatment of choice in
this case.
•
CASE 4:
A 64 Year old man presented to emergency dept with high fever,headache,stiff neck,
photophobia and vomiting for 1 day.

• CSF examination revealed:


• 1.Cell count -85/ul with predominant neutrophil
• 2.CSF protein -50mg/dl
• 3.CSF glucose-80mg/dl
• 4.CSF pressure-100mmH2O

• 5.CSF Grams stain showed 1-2 Pus cell/hpf, and CSF culture was sterile.

• She also gave h/o being diabetic, and her blood sugar level was 260mg/dl on admission.

• 1.What is the probable diagnosis of this clinical condition.

• 2.Name few etiological agents that could lead to this condition.


• 3. what treatment should be given to this patient
CASE 5
A 5 year old girl was admitted to the hospital with
complaints of high grade fever, altered mental status and
neck rigidity.

On examination it was found that there was inability to


strengthen the leg when the hip is flexed to 90®.

CSF sample was collected by lumbar puncture in a sterile


container and sent to Microbiology laboratory for gram
staining and culture.

Gram staining of heaped smear of CSF showed gram


negative coccobacilli.
On a streak of Staphylococcus aureus ,the
colonies also showed satellitism.
• 1.what is your clinical diagnosis.
• 2.Identify the etiological agent.
• 3.What is the preferred t/t of choice for this
condition.
CASE 6
• A 48 year old man came to medicine OPD with headache, low
grade fever, malaise,night sweat, anorexia for the past 2 to 3
weeks.
• CSF examination showed:
• Total count =1000/ul, mostly lymphocytic
• Protein 650mg/dl
• CSF glucose=20mg/dl.
• When CSF was kept in a tube for 12 hours, a coagulum was formed.
•
• What is your clinical diagnosis.
• What other investigations are required to confirm the diagnosis.
• Which Antibiotics should be started in this condition.
CASE 7
• Case 7: A 8 year old boy presented with high grade fever,
vomiting, altered consciousnes , seizures, personality
change, aphasia, ataxia and tremor for 3 days.
• Painful vesicular lesions can also be seen on lips and
Tongue.
• 1. What is your clinical diagnosis.
• 2. What sample should be collected for the diagnosis?
• 3. Name the test to be performed to confirm the
diagnosis.
•
CASE 8
• Case 8: A 10 year old boy residing in Gorakhpur, distt of UP
presented to casualty with fever, mental confusion,
disorientation, delirium and seizures.
• CSF sample was collected .
• 1. Name the investigations that should be performed in this case.
• 2. How the sample should be transported to laboratory.
•
• Further, JERA BASED sandwich ELISA was done and it showed
IgM Ab Specific to JE .
• 3. what treatment should be initiated in this case?
• 4. How this disease can be prevented
CASE 9
A 32 year old vegetarian male presented with sudden 2
episodes of seizure ,and off and on headache, vomiting and
vertigo.
• MRI of brain showed cystic lesion in subarachnoid space
following which surgery was performed.
• The surgically removed cysts have been focused in figure
• 1 .Name the etiological agent.
• 2. various methods to diagnose this condition.
• 3.treatment ?
•
• Thanks

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