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Case 1:

A 14-year-old boy is brought to the emergency department with fever, vomiting, lethargy, and neck stiffness.

CSF Analysis:
- Appearance: Slightly cloudy
- WBC count: 100 cells in nine large squares using WBC Unopettes with 1:20 dilution

Questions:
1. What is the WBC count in the CSF?
2. Describe the CSF findings.
3. What additional tests should be performed on the CSF?

Results of the proposed additional studies:
- WBC differential counts: 86 neutrophils (segmented and band), 7 monocytes, 7 lymphocytes
- Gram stain: Gram-negative diplococci
- Bacterial culture: Pending
- Protein: Elevated
- Glucose: Decreased

4. Based on all the data provided, what condition is most likely?
5. Why does this case represent a medical emergency? What is the significance of clinical laboratory testing in this setting?

Answer :

The WBC count in the CSF is 500 cells/microliter (100 cells in nine large squares multiplied by the dilution factor of 1:20).

2. The CSF findings are indicative of bacterial meningitis. The slightly cloudy appearance, elevated WBC count, and presence of neutrophils (segmented and band) and Gram-negative diplococci suggest an inflammatory response to a bacterial infection.
3. Additional tests that should be performed on the CSF include bacterial culture and sensitivity testing to identify the specific organism causing the infection and determine the most appropriate antibiotic treatment.
4. Based on all the data provided, the most likely condition is bacterial meningitis caused by Neisseria meningitidis.
5. This case represents a medical emergency because bacterial meningitis can rapidly progress and cause severe neurological complications, including seizures, brain damage, and death. Clinical laboratory testing is critical in this setting to quickly identify the underlying cause of the patient's symptoms and guide appropriate treatment decisions, which can significantly improve patient outcomes.

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