Table 1.
Case-patient timeline
| Presenting concerns | Physical examination | Evaluations | Diagnosis | Interventions-Treatments | |
|---|---|---|---|---|---|
| Day of admission | 32-year-old man, carpenter in Lomé No particular medical history 3-day history of headaches, agitation, vomiting, fever |
Body temperature: 36.4 °C Neurological examination: normal Clinical examination: normal | Cranial computed tomography: not performed | Acute meningeal hemorrhage | Symptomatic treatment |
| Day 2 | Persisting symptoms Fever | Neck stiffness Kernig and Brudzinski signs positive | Lumbar puncture: turbid CSFa
CSF analysis: -WBCa: 2,800/mm3 (65 % lymphocytes,35 % neutrophils) - Protein: 1.8 g/L - Glucose: 0.47 g/L (plasma 1.41 g/L; ratio = 0.33) - Gram stain: negative |
Bacterial meningitis | Wide-spectrum antibiotic therapy: ceftriaxone, ofloxacin, metronidazole |
| Day 3 | Vertigo Tinnitus |
CSF culture positive: catalase negative, gram-positive cocci in chains | Adapted antibiotic therapy: ampicillin, gentamicin Corticoid therapy | ||
| Day 4 | Patient reported working as a pork butcher every weekend | Bacterial identification: Streptococcus suis Audiogram: severe hearing loss in left and right ears (80 dB) | Bacterial meningitis due to S. suis with neurological complications | ||
| Month 9 | Tinnitus | Audiogram: severe hearing loss in left and right ears (80 dB) | Neurological sequelae of the meningitis |
a CSF cerebrospinal fluid, WBC white blood cells