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Cerebrospinal fluid interpretation depends on the relationship between cellular composition, protein,
glucose and the clinical presentation, rather than any isolated measurement.
Low glucose means the pathogen consumes sugar, which is true of bacteria,
mycobacteria and fungi, whereas normal glucose points to a virus.
Protein rises in almost every meningitis,
so it cannot discriminate on its own.
The decisive pairing is the dominant cell type with the glucose ratio.
Neutrophils with very low glucose and high pressure indicate bacterial meningitis.
Lymphocytes with normal glucose indicate viral disease,
while lymphocytes with low glucose and very high protein suggest tuberculosis
or fungi.
The sequence of management matters as much as the diagnosis.
Blood cultures are drawn first, antibiotics follow immediately,
and dexamethasone is given before
or with the first dose to limit inflammation from bacterial lysis.
Imaging precedes lumbar puncture only when consciousness is reduced,
deficits are focal or papilloedema is present.
Even then, antibiotics are never delayed for the scan.
Healthy adults receive vancomycin with a third-generation cephalosporin.
However, neonates, adults over fifty,
pregnant women and the immunocompromised also need ampicillin.
Listeria is a gram-positive bacillus that cephalosporins cannot reach,
and vancomycin or ciprofloxacin treat it poorly.
Cerebrospinal fluid interpretation depends on the relationship between cellular composition, protein,
glucose and the clinical presentation, rather than any isolated measurement.
Two other central nervous system infections carry their own rules.
Cryptococcal meningitis in advanced HIV is treated in three phases,
not four weeks.
Induction with amphotericin B and flucytosine lasts at least two weeks,
consolidation with fluconazole eight weeks,
and maintenance continues for a year or until the CD4 count recovers.
Herpes simplex encephalitis burns the temporal lobe
and is treated the moment it is suspected.
Polymerase chain reaction is highly accurate,
yet it may be falsely negative within seventy-two hours
and often stays positive for days after aciclovir begins.
Hospital-acquired infection follows three axes: the device,
the position of the patient and the resistant organism.
Ventilator-associated pneumonia arises from supine aspiration, sedation and the tube itself,
so the bed is raised to thirty degrees or more.
Sucralfate does not raise gastric pH
and therefore does not increase that risk.
Alcohol hand rub fails on visibly soiled hands
and after caring for patients with Clostridioides difficile,
whose spores demand soap and water.
Febrile neutropenia is treated with a single antipseudomonal beta-lactam,
and vancomycin is reserved for line infection, skin infection or instability.
MRSA resists every beta-lactam through the altered target PBP2a,
and daptomycin cannot treat pneumonia because surfactant inactivates it.
Urinary infection is stratified by fever.
Cystitis stays in the bladder, whereas pyelonephritis produces fever,
loin tenderness and nausea.
Escherichia coli causes most cases at both levels.
Recurrent infection in infancy calls for ultrasound first and
then a voiding cystourethrogram to find reflux.
Spinal cord injury above the sacral centre produces a spastic bladder,
while sacral or cauda equina damage produces a flaccid one.
Interstitial cystitis is sterile and should never receive antibiotics.
Cerebrospinal fluid interpretation depends on the relationship between cellular composition, protein,
glucose and the clinical presentation, rather than any isolated measurement.