Differential Diagnosis for Fever with Meningitis Symptoms, Pleocytosis in CSF, and Dramatic Response to Artesunate
- Single Most Likely Diagnosis
- Cerebral Malaria: This is the most likely diagnosis given the dramatic response to artesunate, which is a standard treatment for malaria. Cerebral malaria can present with symptoms of meningitis, including fever, headache, and stiff neck, along with pleocytosis in the cerebrospinal fluid (CSF). The response to artesunate strongly suggests a malaria-related condition.
- Other Likely Diagnoses
- Bacterial Meningitis: Although the response to artesunate is not typical for bacterial meningitis, it's essential to consider this diagnosis due to the severity of the condition. However, bacterial meningitis would typically require antibiotics for treatment, and the response to artesunate might be coincidental or due to another underlying condition.
- Viral Meningitis: Some viral meningitides can present with significant pleocytosis and might improve with supportive care, which could be misinterpreted as a response to artesunate. However, the specific response to artesunate is more indicative of a malaria-related condition.
- Do Not Miss Diagnoses
- Tuberculous Meningitis: This condition can present with chronic meningitis symptoms and pleocytosis. Although the response to artesunate would not be expected, missing this diagnosis could be fatal due to the need for specific antitubercular therapy.
- Fungal Meningitis: Particularly in immunocompromised patients, fungal meningitis (e.g., cryptococcal meningitis) is a critical diagnosis not to miss. The treatment and prognosis are significantly different from bacterial or viral meningitis, and the use of artesunate would not be relevant.
- Rare Diagnoses
- Toxoplasmosis: In immunocompromised patients, toxoplasmosis can cause CNS symptoms that might mimic meningitis. While not typically associated with a response to artesunate, it's a consideration in specific patient populations.
- Leptospirosis: This zoonotic infection can cause meningitis and has a varied presentation. The response to artesunate is not a characteristic feature, but leptospirosis is a rare condition that could be considered in patients with appropriate exposure history.