Pneumococcal Meningitis Presenting With Normocellular CSF
The present and previous cases suggest that bacterial meningitis should be considered in adult patients suspected to have bacterial meningitis, even if the initial CSF cell count is normal, and that Gram staining of the CSF and prompt administration of an adequate dose of antibiotics should be performed with a second CSF examination the following day. This approach is important because the CSF cell count may not be elevated in the first CSF examination, and the presence of Gram-positive cocci in the CSF is associated with high mortality and morbidity in patients with normocellular pneumococcal meningitis.
Conclusions
The present and previous cases suggest that bacterial meningitis should be considered in adult patients suspected to have bacterial meningitis, even if the initial CSF cell count is normal, and that Gram staining of the CSF and prompt administration of an adequate dose of antibiotics should be performed with a second CSF examination the following day. This approach is important because the CSF cell count may not be elevated in the first CSF examination, and the presence of Gram-positive cocci in the CSF is associated with high mortality and morbidity in patients with normocellular pneumococcal meningitis.
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