infectious disease/meningitis

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686463876c78b8d82816dd10

Pediatrics

infectious disease

meningitis

Case History

A 4-year-old girl is brought to a community clinic by her parents with a sudden onset of high fever, severe headache, and repeated episodes of vomiting that began over the last 12 hours. Her parents, recent immigrants, report that her immunization records are incomplete due to challenges in their previous country. On initial assessment, she appears acutely unwell and lethargic, with a temperature of 39.9 C (103.8 F). Physical examination reveals photophobia and noticeable nuchal rigidity. The Kernig's sign is positive. Given these findings, what is the most likely diagnosis and the recommended initial empiric antibiotic regimen?

Lab Parameter	Value	Reference Range
Leukocyte count	22.5 x 10^9/L	4.5-11.0 x 10^9/L
Segmented neutrophils	68%	35-65%
Band forms	20%	<5%
C-reactive protein (CRP)	120 mg/L	<5 mg/L
CSF Opening Pressure	28 cm H2O	5-20 cm H2O
CSF Glucose	1.8 mmol/L	2.2-4.4 mmol/L
Serum Glucose	5.5 mmol/L	3.9-6.1 mmol/L
CSF Protein	2.1 g/L	0.15-0.45 g/L
CSF Gram stain	Gram-negative pleomorphic rods	No organisms seen
CSF Culture on Blood Agar	No growth	No growth
CSF Culture on Chocolate Agar	Growth of small, translucent colonies	No growth

A ) Viral meningitis and supportive care with antipyretics and hydration.

B ) Neisseria meningitidis and empiric treatment with high-dose penicillin G.

C ) Streptococcus pneumoniae and empiric treatment with ceftriaxone and vancomycin.

D ) Haemophilus influenzae type b and empiric treatment with ceftriaxone and vancomycin.

E ) Listeria monocytogenes and empiric treatment with ampicillin and gentamicin.

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