Case study 1c A 70 year old man was

Case study 1c A 70 year old man was brought to the accident andemergency department in status epilepticus. No antecedenthistory was available. He was febrile but therewere no localising signs, as far as could be ascertained.Fundoscopy was not possible: one eye had beenenucleated, the cornea was cloudy on the other side.During immediate resuscitation and control of seizures,blood cultures were taken and he was given high doseintravenous benzylpenicillin. A CT cranial scan did notshow a mass lesion but there were small fluid (pus) levelsin the lateral ventricles. At subsequent lumbar puncture,turbid CSF was obtained, containing 2000 white cells/ml(all polymorphs), protein concentration was 2.8 g/l, andglucose was undetectable. Though the sample provedsterile on culture, Gram positive cocci were seen onmicroscopy and fully sensitive Streptococcus pneumoniaewas grown from the blood cultures. The patient received a14 day course of high dose penicillin and made acomplete recovery.c Comment—This patient presented several years ago,before the polymerase chain reaction and other moderndiagnostic techniques were available. Despite the negativeCSF culture, presumably a consequence of the initialdose of antibiotics, it was still possible to confirm adiagnosis of pneumococcal meningitis from CSF microscopyand blood cultures. The good outcome is perhapssurprising, given the overall prognosis of pneumococcalmeningitis and his condition at presentation. It may in partbe explained by the speed and order of the initialmanagement, antibiotics being given immediately ratherthan waiting for the CT scan and lumbar puncture

Case Study 1
C A 70 year Old Man was brought to the Accident and
Emergency Department in Status epilepticus. No antecedent
history was Available. He was febrile but there
were no localising Signs, As Far As could be ascertained.
Fundoscopy was not possible: one Eye had been
enucleated, the cornea was Cloudy on the Other Side.
During immediate resuscitation and Control of seizures,
blood cultures were taken and. He was given High dose
intravenous benzylpenicillin. A cranial CT Scan did not
Show a mass lesion but there were Small Fluid (PUS) levels
in the lateral ventricles. Subsequent lumbar puncture at,
Turbid CSF was obtained, containing 2,000th White cells / ml
(all polymorphs), protein concentration was 2.8 G / L, and
glucose was undetectable. Though the sample proved
sterile on Culture, Gram positive cocci were seen on
microscopy and Streptococcus pneumoniae fully sensitive
was grown from the blood cultures. The Patient received a
14 Day High dose course of penicillin and Made a
Complete Recovery.
C Presented several years ago Comment-This Patient,
the polymerase chain reaction before and Other Modern
Diagnostic techniques were Available. Despite the Negative
CSF Culture, presumably a consequence of the initial
dose of antibiotics, it was still possible to Confirm a
diagnosis of pneumococcal meningitis from CSF microscopy
and blood cultures. The good outcome is perhaps
Surprising, given the overall PROGNOSIS of pneumococcal
meningitis and his condition at Presentation. It May in Part
be explained by the speed of the initial and Order
Management, being given antibiotics immediately rather
than Waiting for the CT Scan and lumbar puncture.

Case Study 1
C A 70 year old man was brought to the accident and
emergency department in status epilepticus. No antecedent
history. Was available. He was febrile but there
were no, localising signs as far as could be ascertained.
Fundoscopy was not possible:? One eye had been
enucleated the cornea, was cloudy on the other side.
During immediate resuscitation and control, of seizures
.Blood cultures were taken and he was given high dose
intravenous benzylpenicillin. A CT cranial scan did not
show a mass. Lesion but there were small fluid (PUs) levels
in the lateral ventricles. At subsequent, lumbar puncture
turbid CSF was. Obtained containing 2000, white cells / ml
(all polymorphs), protein concentration was 2.8 g / L and
glucose, was undetectable.? Though the sample proved
.Sterile on culture Gram positive, cocci were seen on
microscopy and fully sensitive Streptococcus pneumoniae
was grown. From the blood cultures. The patient received a
14 day course of high dose penicillin and made a
.
- complete recovery C Comment This. Patient presented several, years ago
before the polymerase chain reaction and other modern
diagnostic techniques were available.Despite the negative
CSF culture presumably a, consequence of the initial
dose, of antibiotics it was still possible to. Confirm a
diagnosis of pneumococcal meningitis from CSF microscopy
and blood cultures. The good outcome is perhaps
surprising,, Given the overall prognosis of pneumococcal
meningitis and his condition at presentation. It may in part
.Be explained by the speed and order of the initial
management antibiotics being, given immediately rather
than waiting. For the CT scan and lumbar puncture.