Quiz Form
Question Date: 19/06/2023
Question: A 35 years old male presented with acute meningitis syndrome. His CSF showed proteins 78 mg%, glucose 15 mg% and 350 cells with 90% neutrophils. His cultures did not grow any organism. He was treated with ceftriaxone and vancomycin in meningitic doses for 7 days. There were persistent symptoms even after 7 days. Repeat CSF at 7 days showed proteins 67 mg%, glucose 36 mg% and 170 cells with 85% neutrophils<br><br>What is the likely cause?
Options:
- Acute tubercular meningitis
- Fungal meningitis
- Resistant bacterial meningitis
- Carcinomatous meningitis
Correct Answer: Fungal meningitis
Explaination: In bacterial meningitis, the CSF pleocytosis changes from neutrophils to lymphocytes with treatment<br><br>Persistent neutrophilic meningitis is a poorly described variant of chronic meningitis characterized by the persistence of neutrophils in the CSF over extended periods of time (greater than 1 week) in association with ongoing signs of meningeal inflammation and negative CSF cultures for bacteria and other pathogens<br><br>Most common organisms causing it are<br>- Fungi<br>- Nocardia<br>- Actinomyces
Reference: Peacock JE Jr, McGinnis MR, Cohen MS. Persistent neutrophilic meningitis. Report of four cases and review of the literature. Medicine (Baltimore). 1984 Nov;63(6):379-95.