CASE HISTORY 1

The patient was a 3 2 month-old male who presented in August with a fever of 39.2EC, extreme irritability and vomiting. His fontanelles were normal and his neck was supple. The rest of his examination was unremarkable. A lumbar puncture was done and CSF revealed a WBC count of 75/mm³ with 72% neutrophils, 8% lymphocytes, and 20% monocytes; the glucose level was 60 mg/dl and the protein level was 22 mg/dl (both normal). A Gram stain was negative for bacteria. CSF samples were sent for viral cultures. Intravenous ceftriaxone was begun empirically for presumed bacterial meningitis. Blood, urine, and CSF bacterial cultures were negative and ceftriaxone was discontinued on the second day. He was discharged on the third hospital day as his symptoms were improved. After discharge, his CSF viral culture became positive for an enterovirus.

STUDY QUESTIONS

1. What isolation should the patient be put in?

2. What is known about the pathogenesis of the infection?

3. How is the viral infection detected?

4. Why was there a neutrophil predominance on the LP?

5. What is the appropriate treatment for this viral infection?

6. Would this infection be likely to occur in February?