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Old 05-29-2012
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Question what bug causing meningitis in this case?

A 45-year-old woman with a history of heavy alcohol use is evaluated in the emergency
department for a headache and altered mental status of 2-day's duration. One week earlier
she had a diarrheal illness that quickly resolved.
On physical examination, she is lethargic and unable to follow commands. Temperature is
38.8C (101.9F), blood pressure is 110/70 mm Hg, pulse rate is 105/min, and respiration
rate is 22/min. Jolt accentuation of her headache is present.
The leukocyte count is 14,500/μL (14.5 109/L) with 44% neutrophils, 42% bands, and 13%
lymphocytes; platelet count is 146,000/μL (146 109/L). The serum albumin is 2.6 mg/dL
(26 g/L), the INR is 1.5, and the partial thromboplastin time is 44.1 seconds.
A noncontrast head CT scan is normal. Cerebrospinal fluid (CSF) leukocyte count is 1500/μL
(1500 106/L), with 60% neutrophils and 40% lymphocytes; glucose level is 5 mg/dL (0.3
mmol/L); and protein level is 328 mg/dL (3280 mg/L). The CSF Gram stain reveals
intracellular gram-positive bacilli.
Which of the following is the most likely diagnosis?
(A) Listeria monocytogenes meningitis
(B) Neisseria meningitidis meningitis
(C) Streptococcus pneumoniae meningitis
(D) Viral meningitis
please give reason of high lymphocyte counts and elevated PTT in this question.
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Old 05-29-2012
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(A) Listeria monocytogenes meningitis
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Old 05-29-2012
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Listeria (the only gram positive rod here)
heavy alcoholism is a risk factor, as immunodeficiency state like HIV, malignancy ...
CSF >> bacterial (high count,, low glu, high pro)
CBC >> bandemia (sepsis) >> DIC (Low plt, PTT, INR are starting to rise)


Quote:
Bacterernia: Bacteremia without focus is the most comnon manifestation of listeriosis in compromised persons. Clinical manifestations are similar to other forms of bacteremia. and typically include myalgias and fever.
A prodromal illiess of diarrhea and nausea may occur.

Central Nervous System Infection: CNS infection is most common in neonates and persons over 60 years of age, Listeria is a cause of bacterial(nontuberculous) meningitis in which substantial lymphocytosis can be seen in the CSF differential.
Nice if never give attention to these fact

Last edited by bisho; 05-29-2012 at 09:48 AM.
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Old 05-29-2012
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Quote:
Originally Posted by tyagee View Post
A 45-year-old woman with a history of heavy alcohol use is evaluated in the emergency
department for a headache and altered mental status of 2-day's duration. One week earlier
she had a diarrheal illness that quickly resolved.
On physical examination, she is lethargic and unable to follow commands. Temperature is
38.8C (101.9F), blood pressure is 110/70 mm Hg, pulse rate is 105/min, and respiration
rate is 22/min. Jolt accentuation of her headache is present.
The leukocyte count is 14,500/μL (14.5 109/L) with 44% neutrophils, 42% bands, and 13%
lymphocytes; platelet count is 146,000/μL (146 109/L). The serum albumin is 2.6 mg/dL
(26 g/L), the INR is 1.5, and the partial thromboplastin time is 44.1 seconds.
A noncontrast head CT scan is normal. Cerebrospinal fluid (CSF) leukocyte count is 1500/μL
(1500 106/L), with 60% neutrophils and 40% lymphocytes; glucose level is 5 mg/dL (0.3
mmol/L); and protein level is 328 mg/dL (3280 mg/L). The CSF Gram stain reveals
intracellular gram-positive bacilli.
Which of the following is the most likely diagnosis?
(A) Listeria monocytogenes meningitis
(B) Neisseria meningitidis meningitis
(C) Streptococcus pneumoniae meningitis
(D) Viral meningitis
please give reason of high lymphocyte counts and elevated PTT in this question.
A is answer......I think high lymphocyte count is due to the fact that it is intracellular...?????

PTT rise , no clue.....
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Old 05-29-2012
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Quote:
Originally Posted by bisho View Post
Listeria (the only gram positive rod here)
heavy alcoholism is a risk factor, as immunodeficiency state like HIV, malignancy ...
CSF >> bacterial (high count,, low glu, high pro)
CBC >> bandemia (sepsis) >> DIC (Low plt, PTT, INR are starting to rise)



Nice if never give attention to these fact
very true. also, i thought DIC was specific for N Gonorrhea meningitis. but gram +ve rod made q simple.
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