Patient is 37 year old pig farmer from Laos. He presented with a 5 day history of fever, headache, jaundice and neck stiffness. In the two days prior to admission he had been vomiting and had become increasingly deaf. He had previously been fit and well, although he drank alcohol excessively. Examination revealed a fever of 39°C and confirmed the deafness and neck stiffness but was otherwise unremarkable. Routine haematology and blood chemistry showed only a neutrophil leukocytosis and raised urea and bilirubin. A lumbar puncture performed on the day of admission showed an opening pressure > 40 cmH2O, and yielded turbid CSF with a total cell count of 200 cells/ml (polymorphs 65%, lymphocytes 35%), protein 168 mg/dl, lactate 10 mg/dl and glucose 60 mg/dl (blood glucose 112 mg/dl). India ink and ZN stains were negative.
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Bug challange number 2
Gram stain from CSF
CSF culture on Blood Agar
Source: GlobalHealthMicrobiology
Image credits: David Dance, Sayapeth Rattanavong , Viengmon Davong
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