Day 25/ M p/w gasping breathing with h/o fever, cough and cold for 5 days and difficulty in breathing for 2 days and abnormal movement one episode today, was intubated .CXR s/o haziness in left lung.CSF study protein 140.6 , sugar 50/122 , no cells. CRP 22.8 mg/L. TLC 25400. sodium 135 , potassium 4.6. USG shull normal. Please comment on CNS infection , diagnosis and mgt. ???

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Gasping breathing with involuntary movements most probably due to hypoxic injury to brain.Csf protein elevated with normal sugar with out any cells suggestive of non infective pathology like brain edema hypoxic insult to the brain. Suggest EEg.

Thanx ma'am for helping me to reach the diagnosis
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Aspiration pneumonia with dyselectrolyaemia with respiratory failure is diagnosis Nothing to do with CSF and findings, don't give stress upon that You are doing great Continue symptomatic management and treat septicaemia line along with pneumonia

Thanx for giving your previous time to me
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High probably of CNS involvement..!! Seizure with high protein , low sugar , high esr , low Hb ,high counts Infective etiology suspicious , nil cell can be technical error... Seen after long time leads to cell lysis or faulty method Even in CBC there is high counts , with lymphocytic predominance Lung picture may also be part of same infective etiology or aspiration after seizure After mri if possible repeat csf , get cell counts immediately , look for culture , viral, tb, fungal , blood and et aspirate culture.. Give blanket treatment for meningitis , atypical pneumonia , with att Till definitive etiology...!!!! Is there any specific maternal history , family history ??

Thanx sir for invaluable discussion
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

I have not an expert but wht I can feel tht shared Send a blood c/s Urine c/s Broad spectrum abx Look out liver function test Viral pneumonia Hypothyroid Inborn disorders Po4 and Mg to check out Last NCV EMG study

This is a case of late onset neonatal meningitis which can present with complications like seizures, respiratory involvement and bacteremia. CSF is showing high proteins and low glucose probably bacterial infection. Group b streptococcus, listeria, e.coli, klebsiella can be causative organisms. Start inj cefotaxime or ceftazidime with gentamicin or ampicillin with gentamicin.start anti epileptic medication. Monitor for raised ict.

Pneumonia (ARDS)with anoxic encephalopthy. CSF proteins may be raised at this age without meningitis (no cell).

Sir , is this CSF study showing encephalitis ???
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Late Septicaemia with ARI pneumonitis. Repeat LPand CSF examination and blood culture for Gram postiveand negative organism. Till Ceftriaxone IV can be given.

Give higher antibiotics Maiantain hydration Maiantain vital Decrease work of breathing Proper sedation as per need

With the above reports ..i tink its atypical pneumonia mostly caused by mycoplasma pneumoniae..cz extra pulmonary manifestions like cns involvement can be seen with this(i feel its secondary to pulmonary infection..usually seen btn 5 to 15 yr children as CAP bt studies hv shown to involve below 5 yrs n mostly associated with respiratory viruses too..i.p varies from 1 to 3 wks..bt in severe cases its seen within a week too..as its a cellwall deficient bacteria betalactam drugs wont work n doc would be macrolides(specially azithromycin ) n quinolones which act on DNA.

Thanx sir for putting light on my case
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