Question

An 18 year old college student presents with the sudden onset of fever, headache, myalgias, and nausea and vomiting twelve hours ago. He also complains of neck stiffness and photophobia. Vital signs include temperature 39.7 C (103.5 F), pulse 120, blood pressure 95/60, and respirations 20/min. On physical examination, he is somnolent but arousable. There is pronounced nuchal rigidity. With the hips flexed, attempts to straighten the knee result in spasm of the hamstrings. Small, 1-2mm petechial lesions are present on the trunk, legs, and soft palate. Therapy with intravenous fluid and supplemental oxygen is begun, and lumbar puncture is performed. Which of the following is the most likely finding on CSF analysis in this patient?

A. Increased WBC with neutrophilic predominance, increased protein, decreased glucose
B. Increased protein with oligoclonal bands of IgG
C. Xanthrochromia and increased RBCs
D. Increased WBC with lymphocytic predominance, increased protein, normal glucose
E. Increased WBC with lymphocytic predominance, numerous RBCs, elevated protein, normal glucose

Answer 1

The most likely findings on CSF analysis in a patient with symptoms suggestive of meningococcal meningitis are increased WBC with neutrophilic predominance, increased protein, and decreased glucose.

Step-by-step explanation:

A college student presenting with fever, headache, myalgias, nausea and vomiting, neck stiffness, photophobia, pronounced nuchal rigidity, petechial lesions, and signs of pain on attempting to straighten the knee from a flexed hip position likely has meningococcal meningitis. This is a form of bacterial meningitis that progresses rapidly and is characterized by a fulminant course of symptoms, including petechiae which are indicative of possible Neisseria meningitidis infection. On CSF analysis, the typical findings would include:

• Increased WBC with neutrophilic predominance, as the body responds to bacterial infection with an increase in white blood cells, particularly neutrophils.
• Increased protein, a common feature of bacterial meningitis as a result of the inflammatory response within the CNS.
• Decreased glucose levels, because bacteria consume glucose.

Therefore, the most likely finding on CSF analysis in this patient is increased WBC with neutrophilic predominance, increased protein, and decreased glucose (Answer A).