Question
A patient presents with headache, vomiting, and nuchal rigidity. Guarded LP shows turbid CSF. Microscopy shows 90% PMN cells, sugar of 40 mg/dL (RBS 120 mg/dL), and protein of 200 mg/dL. What is the correct management for this case?
| A. |
Ceftriaxone plus acyclovir
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| B. |
Ceftriaxone plus vancomycin
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| C. |
Cefotaxime plus ampicillin
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| D. |
HRZE
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Show Answer
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Correct Answer � B
Explanation
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The patient shows classic signs of acute bacterial meningitis, supported by:
Clinical features: Headache, vomiting, nuchal rigidity (meningeal signs)
CSF findings:
- Turbid appearance
- 90% PMNs → neutrophilic predominance typical of bacterial infection
- Low CSF glucose: 40 mg/dL with RBS of 120 mg/dL → CSF:serum glucose ratio < 0.4
- Elevated protein: 200 mg/dL (suggestive of blood-brain barrier disruption)
These findings strongly point toward bacterial meningitis, not viral, TB, or fungal causes.
The empiric treatment for community-acquired bacterial meningitis in adults is:
Ceftriaxone (or Cefotaxime) + Vancomycin — to cover penicillin-resistant Streptococcus pneumoniae and Neisseria meningitidis.
Why Other Options Are Incorrect:
A. Ceftriaxone plus acyclovir:
- Acyclovir is for viral (especially HSV) encephalitis, which typically shows lymphocytic predominance in CSF and normal glucose.
- Not appropriate in neutrophilic, low-glucose meningitis.
C. Cefotaxime plus ampicillin:
- Used for neonatal meningitis (to cover Listeria monocytogenes).
- In adults, ampicillin is not typically used unless Listeria is suspected (e.g., elderly, immunocompromised).
D. HRZE (Anti-TB therapy):
- Used for tubercular meningitis, which shows lymphocytic predominance, very low glucose, and subacute/chronic presentation.
- Not for acute bacterial meningitis.
