A febrile old man with xanthochromic hypoglycorrhachia
1MD, Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan.
Germs
|April 11, 2020
Summary
Hypoglycorrhachia, or low cerebrospinal fluid glucose, is a key indicator of bacterial meningitis. Prompt antibiotic treatment guided by CSF analysis, including Gram stain and culture, is crucial for successful recovery without neurological deficits.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Meningitis diagnosis relies heavily on cerebrospinal fluid (CSF) analysis, including Gram stain and culture, before antibiotic administration.
- Hypoglycorrhachia (low CSF glucose) is a significant independent predictor of bacterial meningitis.
Observation:
- A 69-year-old male with alcoholism and liver cirrhosis presented with fever, seizures, and neck stiffness.
- Cerebrospinal fluid analysis revealed extreme hypoglycorrhachia (4 mg/dL), high protein (865 mg/dL), and pleocytosis, indicating bacterial meningitis.
- CSF culture identified *Klebsiella pneumoniae*.
Findings:
- The patient received a 4-week course of meropenem.
- Successful treatment led to recovery without neurological deficits.
Implications:
- Turbid CSF with hypoglycorrhachia strongly suggests bacterial meningitis, even with uncommon pathogens like *Klebsiella* species.
- Tailoring antibiotic therapy based on CSF culture results is vital for favorable patient outcomes.
- Prompt diagnosis and treatment of CNS infections are essential to prevent long-term neurological damage.
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