Correct!
2. The majority of patients have the classic triad of fever, stiff neck and altered mental status.
Only 40% of patients with community-acquired bacterial meningitis have the complete classic triad, as in our case. But patients with bacterial meningitis usually have at least two of the listed signs/symptoms.
In our patient’s case, fever might have been initially masked by the naproxen he took about 3 hours before presentation.
A neurologist examined the patient while a propofol infusion was ongoing. The GCS was 3t, pupils 3mm and reactive, eyes were disconjugate and non-tracking, cough reflex positive. Babinski’s were mute bilaterally. The patient’s neck was supple. The neurologist recommended a lumbar puncture and initiation of high-dose ceftriaxone, vancomycin and acyclovir.
Vancomycin 20mg/kg Q12 hourly, ceftriaxone 2gm Q8 hourly and acyclovir 10 mg/kg Q8 hourly were initiated. A lumbar puncture (LP) was performed by the ICU team. The patient’s CSF was grossly cloudy and an opening pressure was not recorded. The CSF had 21 RBC/mm3, 9,326 WBC/mm3, 92% PMNs/4 monos/4 lymphs. The glucose was <5 mg/dL and protein 921 mg/dL. A gram stain showed few GPC pairs. A PCR panel was positive for S. pneumoniae DNA and negative for all other bacterial and viral pathogens tested (including HSV 1 and 2).
Which of the following are true regarding evaluation and early treatment of suspected community-acquired bacterial meningitis? (Click on the correct answer to be directed to the third of 5 pages)