Bacterial Meningitis w/ Cerebral Malaria

Patient is a male. 28yrs. Wt 78kgs Ht 1.67m BMI 28 COMPLAINTS: Severe headaches x 5 days. Bs for malaria was positive last week. Treated with p-alaxin and got well. However, the headaches have persisted (frontal headaches). Associated with blurry vision, mild neck pains and alot of photophobia. During treatment of malaria he frequency and polydipsia but this has since resolved after taking the antimalarials. Other Labs : FBS, RBS and Urine Analysis were normal. Yesternight client was worse. Severe headaches and photophobia not responding to IV tramadol on any NSAIDS. Client was started on IV Rocephine 2gm bid and IV gentamicin 80mg bid emperically for meningitis 24hrs ago. Today Complete blood count showed as attached. CURRENTLY No headaches. No photobobia. No fevers. Client has mild dizziness and neck pain on flexion of the head. Other systems - Unremarkable What's your diagnosis and plan of management?

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As pbs is +ve for MALARIA but you did not specify which one From symptoms it looks it is P FALCIPARUM HENCE CEREBRAL MALARIA Rx inj artisunate 60mg iv bd With rest of treatment Also take an opinion of opthamologist to r/o optic neuritis as sequele of antimalarial drugs

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Great achievement! Your clinical diagnosis of bacterial meningitis and its appropriate treatment with antibiotic is having desirable response Bacterial meningitis is associated with malaria and its quick diagnosis with prompt treatment is very important, and it can be actually life saving!! Well done

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PL ADD SYMPTOMS SUGGESTIVE OF CEREBRAL MALARIA DRUG = IV QUININE + CLINDAMYCIN / TETRACYCLINE IF YOU THINK ASSOCIATED BACTERIAL MENINGITIS WHICH IS UNLIKELY CSF SHOULD HAVE EXAMINED FOR CELLS GM STAIN PROTEIN SUGAR & CRYPTOCOCCUS BEFORE STARTING ANTIBIOTICS EMPERICALLY

Cerebral malaria = treatment iv QUNININE 20MG / KG BODY WEIGHT DAY 1 WITH 5 % DEXTTROSE 500 CC FOR 4HRS 3 TIME /DAY THERAFTER 1O MG / KG 8 HRLY FOR 7DAYS

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CEREBRAL MALERIA/MENINGITIS ACUTE HEADACHE AFTER COMPLETION OF ANTIMALERIAL INDICATES MENINGITIS DUE TO RESISTANT MALERIA....SO A FRESH COURSE OF EITHER QUININE OR ARTESUNATE I.V SHOULD BE GIVEN WITH BROAD SPECTRUM ANTIBIOTICS ART SHOULD BE GIVEN ANTIBODY ANTIGEN FOR MP, HEAMOGRAM,LFT,RFT,TFT,ALONG WITH CT BRAIN TO BE CARRIED OUT

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? Cerebral malaria,Falciparum malaria CT brain suggested If problems persist, LP to be done

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May be falciparum malaria Rx Artesunate iv BD x 4 days Radical Rx tab primaquine 75 mg stat

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eyes to be tested ask to avoid ABHISYADI diet savarn makshik+mukta pisti+stva giloy early in the morn with honey sunthi mix with milk for local application durva svaras nasya inthe morn shrasolbjrni vati

High protein diet MV tab orally Antioxidants

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?Falciparum Cerebral maleria Primaquinie75 mg stat for redical cure Start artesunate IV BD

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