Blood culture, and bacterial and viral cultures of CSF were sent for study. Parenteral antibiotic therapy was not initiated, and the oral antibiotic was discontinued. CSF latex agglutination tests for Streptococcus pneumoniae, Hib, Neisseria meningitidis serogroups A, C, Y and W-135, and N meningitidis serogroup B/ Escherichia coli K1 were negative. CSF protein 0.78 g/L (normal 0.15 to 0.4 g/L) and CSF glucose 2.6 mmol/L (simultaneous blood glucose level of 5.3 mmol/L). CSF white blood cell (WBC) count was 420×10 6/L, with 80% neutrophils, 15% lymphocytes and 5% monocytes. Initial lumbar puncture revealed cloudy cerebrospinal fluid (CSF), and Gram stain showed moderate neutrophils but no bacteria. No rash was evident, and there were no swollen or painful joints. There were no enlarged cervical nodes, nor signs of hepatosplenomegaly. Tympanic membranes and pharynx appeared normal. Rectal temperature was 39.5☌, heart rate was 126 beats/min and respiratory rate was 24 breaths/min. He was lethargic and had nuchal rigidity. He was immunized previously with four doses of diphtheria- tetanus-acellular pertussis-polio- Haemphilius influenzae b (DTaP-polio-Hib) and a single dose of measles, mumps and rubella (MMR) at 12 months. He was prescribed amoxicillin two days before, and had taken six doses in total. There were no prodromal symptoms, no infectious contacts, no pets at home and no recent travels. A two-year-old boy presented to an emergency room in July with a two-day history of fever, nausea and vomiting.
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