Bacterial meningitis Viral meningitis Fungal meningitis Encephalitis Intracranial mass

lesion
Fever + + + + +
Headache + + + + +
Seizure + + + + +
Lethargy + + + + +
Tachycardia + + + + +
Postictal confusion + + + + +
Kernig’s sign (+) + + + - +
Brudzinski’s sign (+) + + + - +
Intracranial pressure: - -/+ -/+ +
- Opening pressure +
(high)
- Cell count (high) + + -/+ + -/+
Differential count: - -/+ - -/+
- Neutrophils (high) +
- Lymphocytes (low) + - -/+ - -/+
Glucose (low) + - - - -
Total protein (high) + -/+ + + +
Negative Gram’s stain + + - + -/+

For the differential diagnosis, we have bacterial meningitis, viral meningitis, fungal meningitis, encephalitis, and intracranial mass
lesion. These diseases all exhibit fever, headache, seizure, lethargy, tachycardia, and postictal confusion. They also exhibit positive
Kernig’s sign and brudzinski’s sign except for encephalitis. Encephalitis is not associated with negative Kernig's sign or Brudzinski's
sign. These signs are indicative of meningeal irritation, which is more commonly associated with meningitis. Kernig's sign and
Brudzinski's sign are indicative of meningeal irritation and are commonly associated with meningitis. However, they can also be
present in the context of an intracranial mass lesion, such as a brain tumor or abscess. This is because an intracranial mass can
cause increased intracranial pressure, leading to irritation and inflammation of the meninges.

Both bacterial meningitis exhibit high opening intracranial pressure.The intracranial pressure for viral meningitis is typically normal
due to the self-limiting nature of the condition, which does not cause significant inflammation and swelling in the brain and meninges
as seen in bacterial meningitis. Encephalitis is an inflammation of the brain parenchyma and the opening pressure may vary
depending on the underlying cause, severity, and other factors. Opening pressure for fungal meningitis may vary as well.
Bacterial meningitis, viral meningitis, and encephalitis has high cell count in csf In bacterial meningitis, the white blood cell (WBC)
count in the cerebrospinal fluid (CSF) is usually elevated, often greater than 1000 cells/mm3, with a predominance of neutrophils. For
viral meningitis, the CSF WBC count is typically lower than in bacterial meningitis, usually in the range of 10-500 cells/mm3, with a
lymphocytic predominance. In encephalitis, the CSF WBC count is slightly elevated, with a lymphocytic predominance.

For intracranial mass lesions, the cell count in the cerebrospinal fluid (CSF) can vary widely, depending on the underlying cause and the degree of
inflammation. A mild lymphocytic pleocytosis is not uncommon, but in some cases, the cell count may be normal or even elevated, with a
predominance of neutrophils. And then, the variable cell count in fungal meningitis can be attributed to the diverse nature of the underlying
conditions and the host response.

Bacterial meningitis, Fungal meningitis, Encephalitis, and intracranial mass lesion exhibit high Protein count in CSF except for Viral meningitis,
which is variable.

Both Bacterial and Fungal meningitis cause low glucose count, which will be explained later no. As for viral meningitis, encephalitis, and
intracranial mass lesion has normal glucose count and the latter can be varying.

According to harrison’s no 60% in bacterial meningitis has positive gram stain result but, in our case, it was said that it was gram negative
coccobacilli. Gram negative result is also seen in viral meningitis and encephalitis, while fungal encephalitis is rarely positive and as for for
intracranial mass lesion can be varying.

The patient's diagnosis is Acute Bacterial Meningitis, which is likely secondary to the gum infection. Acute Bacterial Meningitis, such as the one in
this case, is considered an acute condition because of the rapid onset and progression of symptoms. The infection can cause the tissues
surrounding the brain to swell, leading to potentially life-threatening complications like paralysis, stroke, and even death if left untreated. The
symptoms, such as sudden onset of fever, headache, and seizure, as well as the laboratory results, including the presence of gram-negative
coccobacilli in the cerebrospinal fluid, suggest that this is a serious and acute bacterial infection