A 46-year-old diabetic male presents with headache, confusion, vomiting and fever


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A 46-year-old diabetic male presents with headache, confusion, vomiting and fever. Examination shows both positive Brudniski neck and Kernig signs. CSF tests show glucose of 55 (50-80), protein of 65 (25-40), elevated opening pressure, WBCs count of peroxidase-positive azurophils leukocytes is 1200 (<5), and no leukocytes of arginine-rich factor are detected. No microorganisms are visualized with any negative-charged stains and acid-fast stains. No growth detected on chocolate agar. The most likely diagnosis of this patient is:

A) Viral meningitis of Herpesvirus
Β) Viral meningitis of Non-Polio Enterovirus
C) Fungal meningitis of Cryptococcus neoformans
D) Bacterial meningitis of Mycobacterium species
E) Bacterial meningitis of Streptococcus pneumoniae
F) Bacterial meningitis of Neisseria meningitidis
G) Bacterial meningitis of Escherichia coli
H) Parasitic meningitis of Amoebae protozoa

it’s E (the age, high WBCs, the WBCs are PMNs or peroxidase positive (neutrophils), no eosinophilia (no leukocytes of arginine-rich factor) (that excludes parasitic)))). In viral lymphocytes which predominate. In TB lymphocytes and monocytes (non-PMNs/agranulocytes) which predominate