A young male aged 30 yrs presented with complaints of Severe Headache, High grade Fever with chills , Nausea since 5 days and Altered Sensorium since 1 day....See his CSF report....Discuss his management....

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Bacterial meningitis likely because Ada being a lymphocyte marker, even just 5 percent lymphocytes of a total of 22400 wbcs,which make a significant total number, may cause Ada to be positive..extremely low sugar with very high proteins with such a large number of cells with a very acute history of fever, headache and altered sensorium makes bacterial etiology very likely..CSF gram stain and culture to be repeated, CSF cbnaat to r/o tbm.to be treated empirically as bacterial meningitis with antibiotics, steroids and supportive care.
It is early TBM most likely as in early neutrophils are dominant cell in csf ADA 11 But bacterial meningitis also possible Go with Xone 2 gm Vanco Akt MRI brain contrast
Acute pyogenic meningitis , with dm, with aki Iv Antibiotics in meningitic doses , with steroids with , hydration... Good glycemic control with insulin
Clinical picture is suggestive of meningo encephalitis Available blood work up & CSF analysis suggestive of Acute bacterial meningitis . Check for immunocompromised state. Start acute bacterial meningitis regimen with steroid , ceftriaxone.vancomycin. Sympyomatic med for fever , head ache.Look dehydrated , correct if any
Acute bacterial meningitis with severe hyperglycaemia & AKI: keto acidosis status is not available but should be treated with insulin, antibiotics, liberal fluids taking care of electrolytes.
Give iV pcm 1gm. IV inj.Voveran inj IV Fluids DNS.RL.10percentDextrose Recording Vitals HR.ly CBP.ESR MP Platelet count Ig.G IM Rx. as per investigation Reports csf Report
Check X-ray chest, daily rft to adjust abx doses, plenty of fluids but avoiding SIADH. short course steroid. First dose of Steroid to be given iv before pushing abx.
Pic shows bacterial meningitis. Neutro predominant. R/o TBM.start of with cefzone n vancomycin. Rpt urea.
Patient shows Bacterial meningitis. Neutro predominant. TBM Start with cefzone n vancomycin
Bacterial meningitis Treat with broad spectrum antibiotics like Meropenem and Vancomycin
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