A 1-month-old female infant was brought to the pediatrician with a 2 day history

Question

A 1-month-old female infant was brought to the pediatrician with a 2 day history of fever up to 100oF. No other symptoms were evident. The physical examination was normal. The infant was sent home with a diagnosis of a mild viral illness. Two days later, the fever spiked to 103oF. The infant was irritable, lethargic, and rejected feedings. There were no other signs or symptoms of a rash, cough, vomiting, or diarrhea. She was brought to the local emergency room.

A lumbar puncture was promptly performed, and a peripheral blood sample was simultaneously collected. A strong suspicion of meningitis existed and the patient was admitted to the pediatric intensive care unit. An aggressive course of antibiotic and antiviral therapy was started. The laboratory values obtained on the spinal fluid and peripheral blood are listed in the table below:

Peripheral Blood WBC count

14,000/L

Peripheral Blood Differential

Neutrophils 32%

Lymphocytes 61%

Monocytes 2%

Serum Glucose

110 mg/dL

CSF Physical appearance

Cloudy, colorless

CSF RBC count

15/L

CSF WBC count

1300/L

CSF Differential

Neutrophils 1%

Lymphocytes 32%

Monocytes 67%

CSF Glucose

35 mg/dL

CSF Total Protein

79 mg/dL

Gram Stain

No organisms seen

Are the peripheral blood WBC count and differential normal or abnormal for a 1-month old infant? (Use the ranges in your textbook as a guide)

Are the CSF cell counts and differential normal or abnormal?

Are the CSF glucose and total protein normal or abnormal?

What diagnosis is suggested by these lab findings? (Be more specific than just meningitis!)

Why did you select the possible diagnosis in the previous question? (What patient symptoms or lab results provided in the case study make you suspect the diagnosis you selected?)

What testing could you perform to prove your suspected diagnosis

Peripheral Blood WBC count

14,000/L

Peripheral Blood Differential

Neutrophils 32%

Lymphocytes 61%

Monocytes 2%

Serum Glucose

110 mg/dL

CSF Physical appearance

Cloudy, colorless

CSF RBC count

15/L

CSF WBC count

1300/L

CSF Differential

Neutrophils 1%

Lymphocytes 32%

Monocytes 67%

CSF Glucose

35 mg/dL

CSF Total Protein

79 mg/dL

Gram Stain

No organisms seen

Explanation / Answer

1). The normal values and the given values of the patient for the peripheral WBC and differential blood count were given below:

Neutrophils 40 - 60%

Lymphocytes 20 - 40%

Monocytes 2 - 8%

Neutrophils 32% (less than normal)

Lymphocytes 61% (greater than normal)

Monocytes 2% (within the normal range)

The blood parameter Normal values Patient's values Peripheral Blood WBC count 9,000-30,000//L 14,000/L (within the normal range) Peripheral blood differential

Neutrophils 40 - 60%

Lymphocytes 20 - 40%

Monocytes 2 - 8%

Neutrophils 32% (less than normal)

Lymphocytes 61% (greater than normal)

Monocytes 2% (within the normal range)

Related Questions

Navigate

• Browse (All)
• Browse A
• Subjects

---

---

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.