1. Based on the Gram stain, what is the likely diagnosis for this patient? Explain the reason behind the answer. 2. How can this patient’s diagnosis be differentiated from other similar clinical presentations?
A 14-year-old high school student with fever, chills, and severe headache is seen in an urgent care clinic. He felt nauseated and vomited before reporting to the clinic. At the clinic, his temperature is 104°F; he has neck rigidity and complains of back pain. Some small petechial spots are noted on his chest and back and in the mouth. Blood is drawn for a complete blood count (CBC) and blood glucose, and lumbar puncture is performed. Cerebrospinal fluid (CSF) is collected sequentially in three sterile tubes and examined.
Blood Results
White cell count: 25 × 109/L
Differential: 80% neutrophils, 10% lymphocytes, 10% monocytes
Glucose: 95 mg/dL
CSF Results
CSF pressure: Increased
Gross appearance: All tubes equally cloudy, not bloody
Glucose: 15 mg/dL
CSF white cell count: 12.0 × 109/L; 90% neutrophils
Questions
1. Based on the Gram stain, what is the likely diagnosis for this patient? Explain the reason behind the answer.
2. How can this patient’s diagnosis be differentiated from other similar clinical presentations?
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