Question 28.1

A 15-year-old previously well patient is admitted to the Emergency Department with headache and photophobia. The CSF result shows as follows:


Patient Value

Adult Normal Range

White Cell Count

100 x 106/L*

< 5


90% neutrophils


2.0 g/L*

0.5 – 0.5


1.0 mmol/L*

> 2.5

Gram stain

Gram positive cocci in chains

a)    State the diagnosis.    (10% marks)

b)    Outline the antimicrobial treatment you would prescribe.    (10% marks)

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College answer

Not available.


a) This protein-rich and glucose-poor CSF is so teeming with angry leukocytes that there is nothing else this could be, other than S.pneumoniae meningitis. 

b) Antimicrobial treatment for pneumococcal meningitis is high dose ceftriaxone (2g q12h) and vancomycin, unless the strain is known to be susceptible to benzylpenicillin.