Chloramphenicol is an excellent drug for meningitis.

Used little in the US because of fear of aplastic anemia. Wide spectrum, covering most gram negative and gram positive bugs that routinely cause meningitis. Also very useful for anaerobic infections. To the right is a an autopsy photo of a case of Streptococcus pneumoniae meningitis. Click here for a larger image. Care should be taken to be sure Adhiambo does not have a pneumonia as well. Treatment is for 14 days

Photo courtesy of: ImmunizationEd.org

An ELIZA for HIV was sent because of Adhiambo's thrush. It was positive.

• Her immunosupression does not relate directly to a risk of meningitis.
• Community acquired meningitis, of many causes, is endemic in Kenya.

Adhiambo's differential diagnosis should include

• Chronic meningitis, such as TB and cryptococcus.
• Meningococcus and other bacteria
• Cerebral malaria

The next patient is a 17 year-old with right-sided weakness and confusion.