复旦大学：《传染病学 Infectious Disease》课程教学资源（MBBS）教案案例（英文）Ten-Year-Old With Fever, Headache, and Neck Stiffness

CID2012:55 Ten Year-old with Fever Headache and Neck Stiffness Case Report Ruan Qiaoling 2014-6-19

Ten-Year-Old With Fever, Headache, and Neck Stiffness Case Report Ruan Qiaoling 2014-6-19 CID 2012;55

Case presentation A 10-year-old previously healthy female A 2-day history of generalized exquisite headache, nausea, vomiting, fever of 39 oC and mild sore throat She had no blurry vision, photophobia, seizure, rash or tick (gF)bites

• A 10-year-old previously healthy female • A 2-day history of generalized exquisite headache, nausea, vomiting, fever of 39 oC and mild sore throat. • She had no blurry vision, photophobia, seizure, rash, or tick (蜱) bites. Case presentation

Personal history 3 weeks prior She consumed goat cheese from Europe She had also been to upstate new york where she hiked in the woods and swam in a lake °6and3 days prior She swam dove, and canoed in a freshwater lake in south carolina and a creek(小溪) Kentucky

Personal history • 3 weeks prior… She consumed goat cheese from Europe. She had also been to upstate New York, where she hiked in the woods and swam in a lake. • 6 and 3 days prior… She swam, dove, and canoed in a freshwater lake in South Carolina and a creek (小溪) in Kentucky

Physical examination Fever:39.2°C Blood pressure: Normal Tachycardia Neck stiffness and positive Kernig's sign

Physical examination • Fever: 39.2 oC • Blood pressure: Normal • Tachycardia • Neck stiffness and positive Kernig’s sign

Laboratory data At outside facility: Serum sodium: 129 mmol/L Peripheral WBC: 16900/uL with 88% neutrophil predominance Lumbar puncture CSF Serum Pressure RBC WBC Protein (mmH2O)(×10°/)(×105/4) N% (mg/L) Glucose glucose (mg/dL)(mg/dL) 370 310 2670 90 10 4210 190 A CSF Gram stain showed no bacterial organisms

Laboratory data • Serum sodium: 129 mmol/L • Peripheral WBC: 16 900/μL with 88% neutrophil predominance. • Lumbar puncture • A CSF Gram stain showed no bacterial organisms. Pressure (mmH2O) RBC (×106/L) WBC (×106/L) N% L% Protein (mg/L) CSF Glucose (mg/dL) Serum glucose (mg/dL) 370 310 2670 90 10 4210 9 190 At outside facility:

Management The patient was given vancomycin, ceftriaxone, and dexamethasone within 2 hours of the examination and was transferred CT of the brain showed no acute intracranial abnormality

Management • The patient was given vancomycin, ceftriaxone, and dexamethasone within 2 hours of the examination and was transferred. • CT of the brain showed no acute intracranial abnormality

Fig 1 Wright's Giemsa-stained cytospin cellular preparation of the patient's cerebrospinal fluid, day of initial presentation, X50

Fig.1 Wright’s Giemsa-stained cytospin cellular preparation of the patient’s cerebrospinal fluid, day of initial presentation, ×50

Fig. 2 Wrights Giemsa-stained cytospin cellular preparation of the patient's cerebrospinal fluid, second day of admission, X50

Fig.2 Wright’s Giemsa-stained cytospin cellular preparation of the patient’s cerebrospinal fluid, second day of admission, ×50

What's your diagnosis?

What’s your diagnosis?

Primary amebic Meningoencephalitis (PAM) 原发性阿米巴脑膜脑炎

Primary Amebic Meningoencephalitis (PAM) 原发性阿米巴脑膜脑炎