| The patient, RV was born April 1997 by suction cup. The birth involved a prolonged second stage of labour. The baby's birth weight was normal- 3.5 kg with no congenital abnormalities noted. CVS and respiratory systems were normal. No icterus (jaundice) was noted.
On July 2nd 1997 physical exam showed increased size of head with a prominent posterior side. Baby showed no social smile and had a history of fever and vomiting for 7 days. No seizures. Hydrocephaly suspected.
On July 4th 1997 surgical consult for ventricular-peritoneal shunt. Prior to surgery, CSF was checked for infection.
1997 Lumbar Puncture (LP) results:
RBC count 34,250
WBC’s 30
Neutrophils 8
Lymphocytes 42
Protein and sugar level not documented
CSF culture-no growth
When the patient’s infection cleared, CMC hospital was able to arrange funding for the cost of the surgery
VP shunt placed with no complications
On July 6th 2009, the patient presented with a history of cough and drowsiness x2 days. She has had a cough and fever during the past two weeks.
Patient was admitted for blood culture and LP due to suspected meningitis.
2009 LP results:
Traumatic Puncture, RBC’s 2,600
No growth on culture
Glucose 55 (normal range is 60% of peripheral blood glucose at time of tap)
Protein 195 mg/dL (normal range is 15-45 mg/dl up to 70 in children)
WBC’s 24
Lymphocytes 48 mm3 ( normal range 0-4 per mm3)
Blood culture shows no growth
Assessment and Plan:
Treat for bacterial meningitis
Daily Ceftriaxone 1g inj.
Ceftrixaone is a third generation cephalosporin. It has activity against gram negative and gram positive bacteria
Acknowledgments: We would like to thank Dr Bose from CHTC Vellore, India, the Gold Foundation, and Dr. Chandy for all his hard work organizing the trip to India and mentoring us while we were there. |
Brief Description