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A 2-year-old female kid with no important old medical history carried to the exigency section by her female parent with a ailment that the kid had flu-like symptoms started yesterday forenoon such as low energy degrees, crossness and little febrility. She besides mentioned that she is a working-mom and the kid normally stays at the day-care centre. Due to child ‘s unwellness, mother decides to remain place with the kid that twenty-four hours. However, symptoms have badly gotten worse through the dark with high febrility, high-pitched inordinate weeping along with sickness and emesis. This is when the female parent realized the badness of the kid ‘s status and brought the kid early in the forenoon to the infirmary. At around 11:00 ante meridiem on the twenty-four hours of admittance, she started holding short periods of tonic-clonic motions on the right side of the organic structure.

Upon the review of the kid, there was a ruddy roseola on the tegument with a little bulging of the soft topographic point on the top of the caput. The patient ‘s female parent claimed her kid non to hold a cough, shortness of breath, abdominal hurting or diarrhoea. Patient did non take any medicines and had no known drug allergic reactions. The kid had high febrility, concern, mildly dehydrated and stiff cervix. There were no unnatural findings in cardiovascular and respiratory systems. The ears and pharynx were normal.

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Further research lab scrutinies have been conducted: Full Blood Count and CSF analysis. WBC count was 22,800/mm3 with 25 % set cells and 70 % polymorphonuclear leucocytes. Electrolyte degrees and thrombocyte counts fell within the normal scope. A lumbar puncture was done, which involves retreating a little sample of cerebrospinal fluid ( CSF ) from the spinal canal with a needle. CSF findings display cloudy fluid with increased neutrophil polymorphs which contained 860 white blood cells and the low glucose degree: 1 mg/dL. The entire protein degree was 450 mg/dL. The gm discoloration and the latex agglutination trial was further performed for bacterial antigens and found positive for Neisseria meningitis. Urine analysis revealed no abnormalcy. Repeatedly after 12 hours, the patient ‘s blood and the CSF was sent for microscopy and civilization.

Etiology

In acute meningitis, infection of the leptomeninges by bacteriums induces an acute inflammatory response. The prevailing bacterial pathogens in immature kids are Streptococcus pneumonia, Haemophilus influenenza and Neisseria meningitides ( MENINGOCOCCAL MENINGITIS ) . The acute inflammatory response causes thrombosis of local blood vass and prevents perfusion to the intellectual cerebral mantle, taking to the terrible encephalon harm instead than the pathogenicity of the bacterium themselves. Through battling processs with the acute inflammatory response to the infection causes more harm than the morbific organism1.

Pathogenesis

Bacterial pathogens exploits host cell signaling tracts to advance its consumption by host cells. The pathogens follow with meningeal invasion and survive within the blood stream and proliferate within the CSF. Chemical go-betweens such as inflammatory cytokines ( eg, interleukin-1 ( IL-1 ) interleukin 8 ( IL-8 ) and tumor mortification factor alpha ( TNF? ) attract neutrophils to the CSF. The neutrophils release big Numberss of lysosomal cytoplasmatic granules that are rich in proteolytic cellular martrix stuffs that break down cell membranes including those of the vascular endothelium. The neutrophil is the key cell to intercede the effects of acute inflammation1. The adhesion of neutrophils to endothelium causes them to aggregate along the vas walls in a procedure termed margination. Endothelium in local vass is activated both by merchandises of tissue harm and by cytokines. Subsequently, the endothelium is modified to go gluey for neutrophils, to release factors interceding vasodilation and to advance thrombocyte adhesion and collection. Neutrophils besides have great phagocytic potency and can actively consume pathogens, which are so destroyed both by lysosomal enzymes and by mechanisms that generate toxic free groups. Acute inflammatory response such as presence of endotoxin and inflammatory go-betweens consequences in thrombosis of local blood vass and decrease in intellectual perfusion1. The vasculitis and thrombophlebitis can finally take to encephalon harm. As a consequence there is an addition in encephalon hydrops and intracranial force per unit area. The pile of purulent exudation created when neutrophils dominate the composing, and stuff is liquefied to organize Pus in the CSF blocks CSF reabsorption1. An acute abscess is a mass of necrotic tissue, with dead and feasible neutrophils. This leads to hydrocephalus. Brain hydrops and hydrocephalus addition intracranial force per unit area.

Diagnosis

CSF Analysis

Brain CT or MRI

The research lab findings and clinical images such as CT suggested a diagnosing of acute bacterial ( Meningococcal ) meningitis. Definitive diagnosing is determined by CSF analysis. CSF force per unit area has been elevated. CSF scrutiny besides reveals cloudy fluid with many neutrophil polymorphs and a low sugar1. Increased protein degree besides suggests bacterial meningitis. Culturing the being on cocoa agar home base to farther distinguish the species and found that the patient is infected by Gram-negative coccus, Neisseria.

Clinical Manifestations

Signs and symptoms for acute bacterial meningitis among immature kids are frequently nonspecific particularly in early disease. Fever, hapless eating, lassitude, purging, crossness and weeping are common presenting symptoms. Seizures and pouching soft spots are possible.

Treatment

Patient is hospitalized for intervention with antibiotics ( penincilin G and Claforan ) and corticoids given intravenously every bit shortly as blood civilizations identified the pathogen.

Prognosis

Prognosis depends partially on the figure of organisms nowadays in CSF at diagnosing and immediate intervention and supportive attention can better result and decreased mortality to less than 10 % .

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