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CASE 1

A 13-month old, white, male, child on the day of admission, seemed fine. According to his mother he had a runny nose and a low-grade fever which she treated with Tylenol. Later in the day, while riding in the car the child suddenly had a grand mal seizure with shaking of the arms and legs. The seizure lasted about 2 min. The mother called an ambulance. The EMT's found the child limp, unresponsive, and apparently post ictal. In the emergency room he had a second seizure. On physical examination he had a temperature of 39.5^oC, pulse of 160/min, and a respiratory rate of 36/min. He was noted to be lethargic, but his neck was supple. Except for a runny nose, the rest of his physical examination was normal. Blood and urine cultures were obtained to rule out sepsis, and the child was begun on intravenous ceftriaxone. His past medical history was significant in that he had not obtained any of the appropriate immunizations for his age.

The patient's mental status did not improve overnight, and a lumbar puncture was performed which showed a cerebrospinal fluid (CSF) white blood cell (WBC) count of 4,650/ml with 95% neutrophils, glucose 48 mg/dl (normal, 50 to 75 mg/dl), and a protein of 107 mg/dl (normal, 15 to 45 mg/dl). Overnight his peripheral WBC count had increased from 6,600 to 14,600 cell per ml. Another physical examination revealed the patient to be irritable, and to have a stiff neck. Another blood culture was positive. There was concern the patient was immunosuppressed. Immunoglobulin levels, complement levels, and lymphocyte function test results were obtained. All the immune function tests were within normal ranges. CSF samples were grown on blood agar plates and chocolate agar plates (see result below). Gram stain of the organism grown from the blood culture is below.

Growth on chocolate and blood agar plates	Gram stain of CSF

1. Which of the following is the best description of the child's CSF?
a. normal WBC count, normal glucose, normal protein.
b. high WBC count, high glucose, low protein.
c. high WBC count, low glucose, high protein.
d. low WBC count, high glucose, low protein.
e. low WBC count, low glucose, high protein.

2. Results from the CSF are indicative of infection with which of the following?
a. viruses
b. fungi
c. bacteria
d. protozoan parasites

3. Name the child's disease (ex. pneumonia, croup) and the etiologic agent (e.g. genus and species, Streptococcus pneumoniae) causing the child's disease.

Answers to the questions can be obtained by clicking on this following link: answers.

Take Care and Think Microbiologically!
Neal R. Chamberlain, Ph.D.

No answers here

Hum. Only grows on chocolate ;)

Pleomorphic Gram Negative rod

A pleomorphic gram negative rod that only grows on chocolate!? THINK Haemophilus.

Answers 1= C; 2= C; and 3= Meningitis; Haemophilus influenzae

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