Bacterial meningitis is always associated with presence of pus cell in CSF giving a turbid appearance. As meningitis is a medical emergency disease, most of the physician as well as bacteriologist suggest immediate antimicrobial administration in these cases. There may be a chance of relaxation during confirmation of the exact cause of the meningitis after finding turbidity ( pus cell ) other than bacterial meningitis and time will pass with the antimicrobial for its respond. But in a case amebic meningo-enchephalitis ( Naegleria fowleri, a free-living thermophilic amoeba found in warm freshwater, enters the nose and migrates to the brain) similar finding with plenty pus cells in CSF, can misguide the bacteriologist as well as the physician. With the passing time with antimicrobial patient will rapidly deteriorate. So, in every pyogenic meningitis, wet film preparation must be done to exclude primary meningo-enchephalitis by seeing the motile amoeba, particularly in case of elderly patient. Recently, two elderly cases ( both were diabetic) died due to pyogenic meningitis in spite of proper antimicrobial therapy in northern area of Bangladesh. Here is a similar case report from CDC http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6245a5.htm?s_cid=mm6245a5_w
Dear Cristina Popescu
Mortality due to meningitis of amoeba etiology is very high, so I emphasized wet film preparation of CSF to exclude this cause earlier during infection particularly in elderly patient who are immune-suppressed or diabetic. Due to high toxicity empirical therapy in meningitis for amoeba etiology is not recommended.
We have at present a case of scrub typhus with eschar,positive serology,tansaminitis and meningitis .Patient's csf examination shows pus cells . Patient has become conscious with doxycycline but his PMN leucocytosis has not settled .Repeat csf examination still showing pus cells .We have now added vancomycin to ceftriaxone . can it be mixed bacterial meningitis with scrub typhus .
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