Ppt Lapkas Meningitisa

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    MENINGITIS

    Presenters : Shella Novita

    Wizni Nadra Lubis

    Supervisor : dr. Tina C. L. Tobing, Sp. A (K)

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    Definisi

    Meningitis is a disease caused by the inflammation

    of the protective membranes covering the brain andspinal cord known as the meninges.

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    Etiologi

    Meningitis

    Bacterial

    Viral

    Fungal

    Parasitic

    Non

    Infectious

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    Pathogenesis

    causative agent

    Invasion of the central nervous system via the blood

    stream

    Migrate to Subarachnoid

    The inflammatory response in

    piamater

    ,

    arachnoid

    ,

    cerebrospinal fluid, and ventricular

    Exudate

    spread across the cranial nerves and spinal

    nerves

    neurological damage

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    Pathogenesis and Pathophysiology

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    Pathogenesis of Tuberculous

    Meningitis

    BTA enter the body

    Common through

    inhalation, rare in the skin,

    gastrointestinal tract

    multiplication

    Pulmonary infection /

    other focus of infection

    Spread homogeneous

    Meningens

    forming tubercles

    BTA is inactive / dormant

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    When theimmune

    system is weak

    Rupture ofmeningeal

    tubercles

    The release ofBTA into the

    subarachnoidMeningitis

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    Diagnosis

    fever, anorexia and poor feeding,

    headache, symptoms of upperrespiratory tract infection,myalgias, arthralgias, tachycardia,hypotension

    nonspecificfindings

    nuchal rigidity, back pain, Kernigsign and Brudzinski sign

    Meningealirritation

    Sign and Symptoms

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    Lumbar Puncture

    Latex Agglutination Tests

    PCR

    sTREM-1

    Blood Culture

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    Management

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    Antibiotic

    Glucocorticoid

    Therapy

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    MEDICAL RECORD

    Name AK

    Age 14 years 7 months oldSex Male

    Address Namo Rambe

    No.RM 54.33.40

    Date of hospitaladmission January 05th 2013

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    History Taking

    AK, 14 years 7 months old, male, weight 35 kg, height 158 cm,was admitted to Haji Adam Malik Hospital at the Infection UnitPediatric Department on January 05th 2013 with main complaintaltered level of consciousness at admission to the ER. It started

    seven days ago starting from seizure once, with duration less than 5minute and frequency less than 3 times a day. Seizure generalized,with eyes rolling up, jerking extremities, and patient fall to sleepafter seizure over. Patient experienced fever since three weeks ago.Fever is fluctuating without chills, and decreased with antipiretic

    drugs. Headache was found since three weeks ago. Cough was notfound. History of contact with an infected person with chroniccoughs was not found. No history of trauma was found. Theres nohistory of complete immunization and BCG scar.

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    History ofBirth

    Appropriate for gestation age (40 weeks),spontaneously, crying immediately and loudly,

    history of cyanotic (-), birth weight = 3700 grHistory ofDevelopment

    6 months old : sitting 10 months old : standing 14 months old : walking

    History ofFeeding

    0-3 months old : breast milk 3-18 months old : breast milk + rice porridge 18 months old until now : family food

    History of

    Immunitation

    DPT : (-)

    Polio : 1 times BCG : (-) Measles : (-) Hep. B : (-)

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    History ofprevious illness

    Varicella at the age of 10 years oldThypoid fever 2 months ago Patient was treated for three day in RSHerna by neurologist and diagnosed as

    meningitis tuberculosis.

    History ofpreviousmedication

    Injection of Meropenem, Dexamethasone,Ranitidine and Dilantin

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    Physical Examination

    Presence

    Status

    Sensorium : GCS7 (E2V1M4), temperature:

    37,8C. Anemic (-), dyspnea (-), cyanotic (-),edema (-), icteric (-).Body weight (BW): 35 kg, body length (BL): 158cm, BW/BL : 97.8%

    Head Eye: Light reflexes (+/+), anisochoric pupil, right = 2 mm, left = 3 mm, pale inferior conj.palpebra (-/-). Ear/ mouth: normal. Nose: nasalecanule and NGT (+)

    Neck Lymph node enlargement (-), nuchal rigidity (+)

    Thorax Symmetrical fusiform , retraction (-)HR: 90 bpm, regular, murmur (-)RR : 18 bpm, regular, rales (-)

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    Abdominal Soepel, peristaltic (+), liver and spleen not

    palpable

    Extremities Pulse = 90 bpm, regular, adequatepressure/volume. Warm acral, CRT < 3 seconds.

    Physiologic Reflex : Right APR/KPR (+ /+),

    Left APR/KPR (+/+)Pathologic Reflex : Babinsky (-), Chaddock (-),

    Schuffner (-),Oppenheim (-/-)

    Meningeal Reflex : Brudzinsky I/II (-/-)Genitalia Male, within normal limit

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    Laboratorium:

    Test(03-1-2013) Results Normal ValueComplete Blood CountHemoglobin (Hb) 11.40 g % 13.018.0 g %Erytrocyte (RBC) 5.09 x 106/mm3 4.56.5 x106/mm3Leukocyte (WBC) 19.80 x 103/mm3 4.510.0 x103/mm3Hematocrite 35 % 38 - 52 %Trombocyte (PLT) 217 x 103/mm3 150450 x103/mm3MCV 70.00 fL 76 - 96 fLMCH 22.00 pg 27 - 32 pgMCHC 31.00 g % 3050 g %ESR 35 mm/h 010 mm/h

    Cell Count:

    Neutrofil 82 % 4060 % Limfosit 11 % 2040 % Monosit 5 % 48 % Eosinophil 1 % 13 % Basophil 0% 01 %

    Renal Function Test:

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    Renal Function Test: Ureum CreatinineElectrolyte: Na K ClSerology:IgM Salmonella typhi

    30 mg/dL0.71 mg/dL135 mEq/L4.3 mEq/L

    100 mEq/L

    +6

    15-45 mg/dL0.7-1.2 mg/dL

    135-148 mEq/L3.8-5.4 mEq/L

    94-111 mEq/L 2 : Negative

    Test (05-1-2013) Results Normal ValueANALYSIS OF CEREBROSPINAL FLUIDColor Clear ClearLDH 200 U/L < 200 U/LTotal Protein 103.20 mg/dL < 45Leukocyte Count 0.56 x 103/uL < 32 x103/uLErytocyte Count 0.002 x 106/uLGlucose 20.2 mg/dL 4076 mg/dLpH 8 78MN Cell 89.5 %PMN Cel 10.5 %

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    Workingdiagnose

    Meningitis Serous

    Management Nasale canule oxygen 0.5-1 L/minute

    30 Head elevationIVFD D5% NaCl 0,9% 25 gtt/minute microdripsMannitol 20% injection 125cc/8 hours/IV (donewithin 1 hour)

    Dexamethasone injection 4mg/6 hours/IVRifampicin 1x525 mgINH 1x350 mgPyrazinamid 1x875 mgEthambutol 1x525 mg

    Sonde voiding diet 1800 kkal with 70 gramprotein

    Investigationplanning

    Consult to neurology divisionConsult to respirology division

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    Chest X-ray (3-1-2013)

    Conclusion : Normal chest x-ray

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    Head CT-Scan (3-1-2013)

    Conclusion : Mild Dilatation Pan Ventricle

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    Brain MRI (3-1-2013)

    Conclusion : Meningitis with inflamation process in dorsal

    midbrain and right portion of cerebellum and hydrocephalus and

    cerebral infarct in right basal ganglia

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    FOLLOW UP

    F ll U J 6th 2013

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    Follow Up January 6th 2013

    S : Altered level of consciousness (+)O: Sensorium : GCS 7 (E2V1M4), weight = 35 Kg, Temperature = 37,2

    0CHead : Eye: Light reflexes (+/+), anisochoric pupil, right = 2 mm, left = 3 mm,

    pale inferior conj. palpebra (-/-). Ear/ mouth: normal. Nose: nasale canule and

    NGT (+)Neck : Lymph node enlargement (-), nuchal rigidity (+)Thorax : Symmetrical fusiform , retraction (-)

    HR: 90 bpm, regular, murmur (-)RR : 28 bpm, regular, rales (-)

    Abdominal : Soepel, peristaltic (+), liver and spleen not palpableExtremities : Pulse = 90 bpm, regular, adequate pressure/volume. Warm acral, CRT

    < 3 seconds. Blood pressure = 90/40 mmHgPhysiologic Reflex : Right APR/KPR (+ /+), Left APR/KPR (+/+)Pathologic Reflex : Babinsky (-), Chaddock (-), Schuffner (-),

    Oppenheim (-/-)

    Meningeal Reflex : Brudzinsky I/II (-/-)

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    A : Meningitis SerousP :

    Nasale canule oxygen 0.5-1 L/minute 30 Head elevation IVFD D5% NaCl 0,9% 25 gtt/minute microdrips Ceftriaxone injection 1g/12 hours/IV (H2) Mannitol 20% injection 125cc/8 hours/IV (done within 1 hour) Dexamethasone injection 4mg/6 hours/IV Rifampicin 1x525 mg INH 1x350 mg Pyrazinamid 1x875 mg Ethambutol 1x525 mg Sonde voiding diet 1800 kkal with 70 gram protein

    Follow Up January 7th 2012

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    Follow Up January 7th 2012

    Pediatric Neuorologist Consultation:Diagnose : Meningitis SerousTreatment : Phenytoin 700 mg injection in 70 cc NaCl (done within 20 minutes), for

    next 12 hours phenytoin 90 mg in 9 cc NaCl 0.9%/ 12 hoursMantoux test done in left volar (lower arm). Read at Thursday, January 10th

    2013.Ophtalmologist Consultation:

    Diagnose : Conjunctivitis OSTreatment : C. floxa 4x1 gtt (OS)

    C. lyteers 4x1 gtt (ODS)Eyes covered by wet (by RL) sterile gauze

    Electrolyte Check Result: Hyponatremia (Na = 125 mEq/L).Corrected by NaCl 3% 420 cc (105 gtt/minute microdrips)Balance :Input = 845cc Different = - 255cc Output = 1100cc

    F ll U J 8th 2013

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    Follow Up January 8th 2013

    S : Altered level of consciousness (+), Fever (+)

    A : Meningitis Serous + Conunctivitis OS

    P :

    Ceftriaxone injection 1g/12 hours/IV aff IVFD NaCl 3% 350cc/12 hours (done within 2 hours) electrolyte recheck

    Diamox pulvers 3x250 mg

    Ibuprofen pulvers 4x400 mg

    Phenytoin injection with maintenance dose 90 mg/12 hour/iv diluted in 9 cc NaCl 0.9%

    is given over in 20 minute

    Eyes cover with wet (RL) sterile gauze

    Balance :

    Input = 1440cc Different = - 485cc Output = 1925cc

    Urine Dipstic:

    LEU NIT URO PRO pH BLO SG KET BIL GLU

    - - 0.2 - 6.0 +++ 1.005 - - -

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    Test(8-1-2013) Results Normal Value

    Electrolyte: Na K Cl Ca P Mg

    133 mEq/L4.9 mEq/L102 mEq/L8.3 mEq/L2.8 mEq/L2.27 mEq/L

    135-155 mEq/L3.6-5.5 mEq/L96-106 mEq/L9.2-11 mEq/L3.4-6.2 mEq/L1,3-1,8 mEq/L

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    Follow Up January 9th 2013

    S : Altered level of consciousness (+), Blood in NGT (+), Fever (-)

    A : Meningitis Serous + Conunctivitis OS

    P : Sonde voiding diet 1800 kkal with 70 gram protein fasting for cooling spooling

    Balance :

    Input = 775cc Differernt = - 425cc Output = 1250cc

    Urine Dipstic:

    LEU NIT URO PRO pH BLO SG KET BIL GLU

    - - 0.2 7.0 ++ 1.005 - - -

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    Follow Up January 10th 2013

    S : Altered level of consciousness (+), Clear NGT (+)

    A : Meningitis Serous + Conunctivitis OS

    P :

    Nebule of NaCl 0.9% 2.5cc + Ventolin

    Suction regularly every 2 hours

    Sonde voiding diet 1800 kkal with 70 gram protein

    Balance :

    Input = 1225cc Differernt = - 425cc Output = 1650cc

    Urine Dipstic:

    LEU NIT URO PRO pH BLO SG KET BIL GLU- - 0.2 5.0 + 1.025 - + -

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    Test(8-1-2013) Results Normal ValueBlood Gases: pH pCO2 pO2 HCO3 Total CO2 BE SaO2

    7.42918.4 mmHg107.3 mmHg11.9 mmol/L12.5 mmol/L-10.0 mmol/L

    98%

    7.35-7.4538-42 mmHg

    85-100 mmHg22-26 mmol/L

    19-25 mmol/L

    (-2)(+2) mmol/L95-100%

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    Follow Up January 11th 2013

    S : Altered level of consciousness (+)

    A : Meningitis Serous + Conunctivitis OS

    Balance :

    Input = 1430cc Differernt = 95cc Output = 1325cc

    Urine Dipstic:LEU NIT URO PRO pH BLO SG KET BIL GLU

    - - 0.2 + 6.0 - 1.015 - -

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    Follow Up January 12th 2013

    S : Altered level of consciousness (+) , vesicles on left side of neck (+), blood in urinary

    cathteter (+)

    O : Head : OFT (+)

    Neck : vesicle (+) multiple on left side of neck, ulcer (+) on back side of neck

    A : Meningitis Serous + Conjunctivitis OS + Susp. Herpes Zooster + Hematuria ec Susp.

    UTI + Pressure ulcer

    P :

    Zinc 1x10 mg

    Chest physiotherapy

    Balance :

    Input = 1980cc Differernt = 605cc Output = 1375cc

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    Test(12-1-2013) Results Normal ValueElectrolyte: Na K Cl Ca P Mg

    132 mEq/L4.0 mEq/L107 mEq/L7.5 mEq/L3.6 mEq/L

    1.95 mEq/L

    135-155 mEq/L3.6-5.5 mEq/L96-106 mEq/L9.2-11 mEq/L3.4-6.2 mEq/L

    1,3-1,8 mEq/L

    Hypocalcemia Correction: 0.5xBB = 0.5x35 = 17.5 cc Ca gluconas in 17.5 cc Dextrose 5%

    (done within 20 minutes)

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    Test(12-1-2013) Results Normal ValueUrinalysis Color Glucose Bilirubin Keton SG pH Protein Urobilinogen Nitrit Blood

    Yellow

    NegativeNegativeNegative

    1.0256.0

    NegativeNegativeNegativePositive

    YellowNegativeNegativeNegative

    1.005-1.0305-8

    NegativeNegativeNegative

    Urine Sediment: Eritrocyte 10-15 < 3 Leucocyte 3-5 < 6 Epitel 0-1 Cast Negative Negative Cristal Negative

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    Follow Up January 13th 2013

    S : Altered level of consciousness (+), vesicles on left side of neck (+), blood in urinary

    cathteter (+)

    A : Meningitis Serous + Conjunctivitis OS + Susp. Herpes Zooster + Hematuria ec Susp.

    UTI + Pressure ulcer

    Balance :

    Input = 1950cc Differernt = 225cc Output = 1725cc

    Urine Dipstic:

    LEU NIT URO PRO pH BLO SG KET BIL GLU

    - - 0.2 5.0 - 1.015 - - -

    Follow Up January 14th 2013

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    Follow Up January 14 2013

    S : Altered level of consciousness (+), vesicles on left side of neck (+), blood in urinary

    cathteter (+)

    A : Meningitis Serous + Conjunctivitis OS + Susp. Herpes Zooster + Hematuria ec Susp.

    UTI + Pressure ulcer

    P :

    Gentamycin cream

    Acyclovir cream

    Acyclovir 5x800 mg

    Blood Cultur : No micoorganisme growth

    Balance :

    Input = 1400cc Differernt = -100cc Output = 1500cc

    Urine Dipstic:

    LEU NIT URO PRO pH BLO SG KET BIL GLU

    - - 0.2 ++ 6.0 - 1.015 - -

    Follow Up January 15th 2013

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    o ow Up J u y 5 0 3

    S : Altered level of consciousness (+), vesicles on left side of neck (+), blood in urinary

    cathteter (-)

    A : Meningitis Serous + Conjunctivitis OS + Susp. Herpes Zooster + Susp. UTI +

    Pressure ulcer

    Balance :

    Input = 1750cc Differernt = 225cc Output = 1525cc

    Urine Dipstic:

    LEU NIT URO PRO pH BLO SG KET BIL GLU

    - + 0.2 - 6.0 1.010 - - -

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    Test(14-1-2013) Results Normal ValueUrinalysis Color Glucose Bilirubin Keton SG pH Protein Urobilinogen Nitrit Blood

    Yellow

    NegativeNegativeNegative

    1.0205.0

    NegativeNegativeNegativePositive

    YellowNegativeNegativeNegative

    1.005-1.0305-8

    NegativeNegativeNegative

    Urine Sediment: Eritrocyte 1-3 < 3 Leucocyte 0-1 < 6 Epitel 0-1 Cast Negative Negative Cristal Negative Others Yeast (+)

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    Nephrology Division Consultation : Repeat Urinalysis and urine culturMedical Rehabilitation Consultation : Treatment every 3 days as IR, Chest FR

    and Body moving

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    Follow Up January 16th 2013

    S : Altered level of consciousness (+), vesicles on left side of neck (+)

    A : Meningitis Serous + Conjunctivitis OS + Susp. Herpes Zooster + Susp. UTI + Pressure

    ulcer

    Balance :

    Input = 1450cc Differernt = - 850cc Output = 2300cc

    Urine Dipstic:

    LEU NIT URO PRO pH BLO SG KET BIL GLU

    - + 0.2 - 6.0 1.010 - - -

    Test(16-1-2013) Results Normal Value

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    Complete Blood CountHemoglobin (Hb) 10.00 g % 12.014.4 g %Erytrocyte (RBC) 4.31 x 106/mm3 4.204.87 x106/mm3Leukocyte (WBC) 18.07 x 103/mm3 4.511.0 x103/mm3Hematocrite 31.70 % 43 - 49 %Trombocyte (PLT) 378 x 103/mm3 150450 x103/mm3MCV 73.50 fL 85 - 95 fLMCH 23.20 pg 28 - 32 pgMCHC 31.50 g % 3335 g %RDW 23.40 % 11,614,8 %MPV 7.90 fL 7,210,2 fLPCT 0.30 %PDW 7.6 fLESR 44 mm/h < 15 mm/hCell Count: Neutrofil 86.80 % 3780 % Limfosit 5.30 % 2040 % Monosit 4.10 % 28 % Eosinophil 3.70 % 16 % Basophil 0.100 % 01 % Neutrophil absolute 15.68x103/L 2.47.3 x103/L Limfosit absolute 0.96x103/L 1.75.1 x103/L Monosit absolute 0.74x103/L 0.20.6 x103/L

    Eosinophil absolute

    0.67x10

    3

    /L

    0.100.30 x10

    3

    /L

    Basophil absolute 0.02x103/L 00,1 x103/L

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    Liver Function: Total Bilirubin Direct Bilirubin ALP SGOT SGPTRenal Function: Ureum

    Creatinine

    Uric acidElectrolyte: Na K

    Cl

    Ca P Mg

    0.56 mg/dL0.19 mg/dL

    96 U/L43 U/L45 U/L

    24.70 mg/dL0.36 mg/dL

    3.9 mg/dL

    129 mEq/L3.4 mEq/L100 mEq/L7.8 mEq/L4.4 mEq/L2.10 mEq/L

    < 1 mg/dL0-0.2 mg/dL< 390 U/L< 38 U/L< 41 U/L

    < 50 mg/dL0.57-0.87 mg/dL

    < 7.0 mg/dL

    135-148 mEq/L3.8-5.4 mEq/L94-111 mEq/L9.2-11 mEq/L3.4-6.2 mEq/L1,3-1,8 mEq/L

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    Follow Up January 17th 2013

    S : Altered level of consciousness (+), vesicles on left side of neck(+)

    A : Meningitis Serous + Conjunctivitis OS + Cristalina Miliaria + Susp. UTI + Pressure

    ulcer

    P :

    Acyclovir cream 2x1 aff Acyclovir 5x800 mg aff

    Urine Cultur : Fungal (+)

    Dermatologist Consultation : Diagnose : Cristalina Miliaria

    Treatment : Hydrocortisone 2.5% sue 2x1

    Balance :

    Input = 2700cc Differernt = -50cc Output = 2750cc

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    Follow Up January 18th 2013

    S : Altered level of consciousness (+), vesicles on left side of neck(+)

    A : Meningitis Serous + Conjunctivitis OS + Cristalina Miliaria + Susp. UTI + Pressure

    ulcer

    P :

    Hydrocortisone 2.5% cream 2x1

    Balance :

    Input = 1350cc Differernt = 500cc Output = 850cc

    Urine Dipstic:

    LEU NIT URO PRO pH BLO SG KET BIL GLU

    + - 0.2 - 6.0 - 1.015 - - -

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    Test(18-1-2013) Results Normal ValueElectrolyte: Na K Cl Ca P Mg

    118 mEq/L3.4 mEq/L96 mEq/L7.5 mEq/L3.2 mEq/L1.78 mEq/L

    135-155 mEq/L3.6-5.5 mEq/L96-106 mEq/L9.2-11 mEq/L3.4-6.2 mEq/L1,3-1,8 mEq/L

    Hyponatremia Correction : (135-118) x 0.6 x 35 = 357 mEq/L

    Corrected by : NaCl 3% = (357/513) x 1000 = 695 L (done within 4 hours)

    174 gtt/i microdrips = 56 gtt/i macrodripsHypocalcemia Correction : 0.5 x 35 = 17.5 cc Ca gluconas in 17.5 D5% IV Bolus

    (done within 20 minutes)

    T (18 1 2013) Results Normal Value

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    Test(18-1-2013) Results Normal ValueUrinalysis Color Glucose Bilirubin Keton SG pH Protein Urobilinogen Nitrit Blood

    Yellow

    NegativeNegativeNegative

    1.0206.0

    NegativeNegativeNegativePositive

    YellowNegativeNegativeNegative

    1.005-1.0305-8

    NegativeNegativeNegative

    Urine Sediment: Eritrocyte 5-10 < 3 Leucocyte 10-15 < 6 Epitel 0-1 Cast Negative Negative Cristal Oxalat 1-2 Others Yeast (+), hifa (+)

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    Follow Up January 19th 2013

    S : Altered level of consciousness (+), vesicles on left side of neck(+)

    A : Meningitis Serous + Conjunctivitis OS + Cristalina Miliaria + Susp. UTI +

    Pressure ulcer

    P :

    Fluconazole injection loading dose 12 mg/kgBB/IV (400 mg IV)

    maintenance dose 6 mg/kgBB/IV (100 mg IV)

    Balance :

    Input = 1650cc Differernt = -375cc Output = 2025cc

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    Follow Up January 20th 2013

    S : Altered level of consciousness (+), vesicles on left side of neck(+)

    A : Meningitis Serous + Conjunctivitis OS + Cristalina Miliaria + Susp. UTI +

    Pressure ulcer

    Balance :Input = 1550cc Differernt = 150cc Output = 1400cc

    Urine Dipstic:

    LEU NIT URO PRO pH BLO SG KET BIL GLU

    - - 0.2 - 6.0 ++ 1.030 - - -

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    Follow Up January 20th 2013

    S : Altered level of consciousness (+), vesicles on left side of neck(+)

    A : Meningitis Serous + Conjunctivitis OS + Cristalina Miliaria + Susp. UTI +

    Pressure ulcer

    Balance :Input = 2100cc Differernt = 800cc Output = 1700cc

    Urine Dipstic:

    LEU NIT URO PRO pH BLO SG KET BIL GLU

    - - 0.2 - 6.0 - 1.015 - - -

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    DISCUSSION

    Theor Case

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    Theory CaseSymptoms often appear are fever,headache, and stiff neck and someaccompanying symptoms such as

    nausea, vomiting, photophobia,impaired mental status, severemeningitis symptoms that may occur isa seizure until coma.

    Some of the symptoms above can befound on the case, i.e., fever,headache, stiff neck accompanied by

    weight of the seizure symptoms ofmeningitis.

    Diagnosis is confirmed by examination

    of cerebrospinal fluid (CSF) andidentification of bacteria, viruses orfungi, by culture or detection antigen.

    Lumbar puncture performed on the

    patient. Examination showed thatthere was no increase in the amount ofprotein CSF. CSF normal protein levels,a slight increase, or decrease can befound in meningitis viral.

    For tuberculous meningitis, thediagnosis is confirmed based on clinicalfeature and ziehl-neelsen gramstaining.

    In this case, the patient show alteredlevel of consciousness, seizure,recurrent fever and headache thatindicates sign of central nervoussystem infection.

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    Theory CaseOn acute bacterial meningitis and thechronic decline in glucose levels (< 40mg/dL) and high protein (usually 100-500 mg/dL)8. In some studies, theanalysis of culture fluid CSS with

    negative bacterial colonies are oftencaused because the patient hasreceived antibiotic therapy before LP.

    CSF fluid analysis results of thepatients showed clear color with a lowin glucose levels (20.2 mg/dl normalvalue 40-76 mg / dl) and high proteinlevels (103.20 mg/dL normal

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    Summary

    Patients, M, a 14 days old baby wasdiagnosed with meningitis ec Staphylococcusepidermidis. A comprehensive treatment to

    manage meningitis has been conducted tothis patient. He has been stabilized, and thenhe discharge by his own request.

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