Question

Case Study 6

A 23-year-old male presented to the ER with a 5-day history of fever, headache, sore throat, muscle pain, nausea, and diarrhea. He described his headache as a 10/10 on a pain scale and was worsened by bright lights, movement, or noise. He had migraines in the past but stated this felt different. He said there was not a prior history of head injury, chest pain, or ear pain. He does not have abdominal pain, dysuria, or a skin rash. No recent alcohol or illicit drug use, travel, or exposure to ticks. Upon physical exam he had right-sided tonsillar exudates and swelling. Even though neck pain was described with his headache, the neck was supple. Following lumbar puncture, 4 nucleated cells and 87% lymphocytes were shown. CSF protein and glucose were within normal limits. He had a normal white blood cell count but a low blood lymphocyte count of 720 cells/uL (normal is 1500 – 5000/uL). Chest radiograph came back normal. CSF was sent for herpes simplex virus (HSV) PCR and for bacterial culture. No organisms were detected upon gram staining. Urine was obtained for bacterial culture and chlamydia and gonorrhea testing. Blood was drawn for routine bacterial cultures and Monospot test. Upon further questioning about the patient’s history it was revealed he was sexually active as a man who has sex with men and unreliable condom use. The patients last HIV test was 2 months ago and was negative. Patient was admitted for further evaluation.

1. ​What is the patient’s diagnosis?

2. ​What populations are at increased risk for infection with this agent?

3. ​Describe the pathogenesis of this infection? What is the natural history of this infection?

4. ​How should this patient’s infection be managed?

5. ​Discuss approaches to controlling the spread of this infection.

Answer 1

1. Viral meningitis

2. Adolescent and young peoples are high in infection.

3. The virus enters CNS through replication from outside, hematogenic spread or enterovirus , then spreads in sub arachnoid spaces via CSF then inflammatory reactions leads to meningitis.

4. Supportive therapy

• Promote rest
• Anti inflammatory drugs
• Antipyretics
• Maintain hydration
• Specific treatment after confirm virus

5.

Precautions

• Aware of vaccines
• Protect from insects bites
• Children's should be vaccinated