Question
A 4-year-old male child presented with a history of high-grade fever and altered sensorium. He has a history of repeated OPD visits for CSOM for the last 2 years. After initial assessment and stabilization, CSF analysis was done, and resident started i.v Ceftriaxone and inj. Dexamethasone. Which among the following statements justifies the treatment that was initiated?
| A. |
High protein content and polymorphous nuclear cells in the CSF
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| B. |
AFB positive bacilli in CSF
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| C. |
PCR positive for Herpes
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| D. |
Normal CSF analysis
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Show Answer
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Correct Answer � A
Explanation
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Ans. A. High protein content and polymorphous nuclear cells in the CSF
Acute onset high-grade fever and altered sensorium in the backdrop of a chronic suppurative otitis media makes bacterial meningoencephalitis much likely.CSF studies suggestive of high neutrophils, low sugar, and high protein along with neuroimaging can confirm the diagnosis. A broad-spectrum antibiotic with good CNS penetration must be chosen (as a third-gen cephalosporin) along with steroid ( usually dexamethasone) to prevent complication like SNHL especially with a suspected H.inluenza infection
In neuro-tuberculosis ( AFB +ve in CSF ), there will usually be a subacute or chronic history of symptoms with progression.
Herpes encephalitis would have red blood cells and lymphocytic infiltrates on the CSF analysis.
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