NEUROLOGICAL CASE HISTORY (CLINICAL VIROLOGY)

Neurological Case History (Clinical virology)

Neurological Case History (Clinical virology)

Introduction

Meningitis is an inflammation of the brain and spinal cord, the shells of the central nervous system (CNS). The viruses and bacteria may be caused or other microorganisms, but also occur due to non-infectious stimuli. Since bacterial meningitis due to the proximity of the inflammation to the brain and spinal cord is generally life-threatening meningitis is to secure the exclusion of a bacterial cause always a medical emergency.

The most common symptoms of meningitis are headache and neck stiffness associated with fever, confusion or loss of consciousness, nausea and sensitivity to light and loud noises. Children in particular can show, especially in the initial phase, and non-specific symptoms such as irritability and drowsiness (Rodrigues-Morales, 2011, pp. 21-25). A characteristic rash is considered an indication of the presence of meningococcal meningitis caused. 

Usually, the presence of the disease is through the analysis of cerebrospinal fluid, which by a lumbar puncture is removed confirmed or ruled out. Meningitis is the timely administration of antibiotics and if necessary treated with antiviral agents. Corticosteroids may be helpful for the prevention of complications. Meningitis can be, especially if it is not diagnosed and treated, fatal or cause serious sequelae such as deafness, epilepsy, a hydrocephalus or cognitive impairments lead. To protect against specific pathogens of meningitis vaccinations exist.  Meningitis with certain pathogens such as Haemophilus influenza type B meningococcal meningitis or are notifiable diseases (Sullivan, 2008, pp. 1102-03).

Case Report:

The case started by identifying the patient by the name of Rolf, aged 17 years, is taken to accident and emergency by his parents because he has developed a headache and is complaining that bright light hurts his eye. When examined in A& E he is found to be febrile and to have neck stiffness. The doctor diagnosis meningitis and gives 1 g of the antibiotic ceftriaxone. She collects blood for biochemistry tests, for a full blood count and for bacterial culture. A lumber puncture is carried out to collect cerebrospinal fluid (CSF). It was found that the opening pressure is normal and CSF is clear and colorless.

After laboratory examination the following figures are reported to the CSF:

White blood cells: 400/mm3

Differential: Neutrophils 15%, Lymphocytes 85%

Red blood Cells :< 5/mm3

Gram Stain: No bacteria seen

Protein: 0.6 g/L (Normal < 0.4 g/L)

Glucose: CSF: Serum ratio 0.62 (Normal > 0.6)

These findings are consistent with viral meningitis because of lymphocytosis, raised protein, normal glucose level, normal opening pressure, clear CSF and nothing seen in gram stain.

Three samples from Rolf are given to use to make diagnosis: Blood (For antibody testing), throat Swab (for virus culture) and CSF (for virus culture and PCR). A serum sample, throat swab and cerebrospinal fluid were obtained from Rolf in order to make diagnosis for his meningitis. At this stage no information was available about his immune status, whether he was vaccinated for MMR or not. The serum sample was tested by ELISA for IgM and IgGantibodies against mumps viruses.

Information about the test used: Bioelisa Mumps Igm and another bioelisa Mumps IgG, Elisa test for the detection of antibodis to Mumps Virus in human serum or plasma). The Throat Swab was used to infect Vero cells culture, presence of the Cytopathic effect after 24-48 hours would assist in the diagnosis ...