A 20 year-old man presented to the emergency department with a 4-hour history of severe bifrontal headache, neck pain and vomiting associated with fever and a 1-week history of productive cough. About 5 months earlier he had been admitted to another hospital with Streptococcus pneumoniae meningitis. On presentation, the patient was found to have fever, tachycardia, nuchal rigidity, positive Kernig and Brudzinski signs and leukocytosis. Lumbar puncture revealed an elevated leukocyte count and neutrophilia and no detectable glucose, although Gram's staining of a sample of his cerebrospinal fluid (CSF) was negative. The patient's condition improved dramatically over 24 hours after empirical treatment with ceftriaxone, vancomycin and dexamethasone. Blood cultures eventually grew S. pneumoniae sensitive to penicillin.
Two cases of Coxsackie B viral meningo-encephalitis in pregnant women are described. Both patients recovered well and delivered healthy babies, but because of delay in establishing the aetiology of their infections both mothers, and one child, received acyclovir therapy. The differential diagnosis of non-pyogenic meningo-encephalitis in late pregnancy can present particular problems: clinicians caring for such women should remain aware of the potential for enteroviral infection in their patients, and take appropriate action to prevent cross-infection in neonatal units.
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