Case Study Help

Hi! I'm having a hard time with this case study. Having never done one, i dont know where to even start. Any help or advice (or answers:p) would be appreciated.

The patient was a 3 1/2 month old male who presented in august with a 2-week history of diarrhea which abated with oral rehydration. One week later, he developed a fever and right otitis media. He was treated with pediazole for presumed chlamydia infection. He continued to have fever and developed irritability and vomiting. He returned to the clinic and was admitted to the medical center.

On physical examination, he was irritable and had a temperature of 36.6 degrees C. He had tachycardia with a pulse of 180bpm. His blood pressure was normal. His fontalles were normal. His neck was supple. His tympanic membranes were dull and distorted bilaterally. The rest of his examination was unremarkable. Laboratory tests showed anemia with a hemoglobin level of 10.4g/dl; the WBC count was 9300/microliter with 60% lymphocytes. Electrolyte levels were normal. A Lumbar puncture was done and the CSF revealed a WBC count of 75/microliter with 72% neutrophils, 8% lymphocytes, and 20% monocytes; the glucose level was 60mg/dl and the protein level was 22 mg/dl (both normal). a Gram-stain of the CSF was negative for bacteria but showed the presence of a few polymorphonuclear leukocytes (PMNs).

CSF samples were sent for viral cultures. IV cefriaxone and ampicillin were begun empirically for presumed bacterial meningitis. One day later his anterior fontanelle was full. A head computed tomogram (CT) scan was normal. On the second hospital day his condition had improved and his anterior fontanelle was less full. Blood, urine, and CSF bacterial cultures were all negative. He was discharged on the fourth hospital day to complete a 10-day course of IM ceftriaxone on an outpatient basis.

After discharge, his CSF viral culture became positive for the etiological agent.

I have a list of viruses it can be limited to. Some being not even close. But i've narrowed it down to 3. (if i'm not right, please let me know) I am thinking its the cocksackievirus, echovirus, or enterovirus. (from my understanding cocksackievirus and echovirus are types of enteroviruses, but the prof. said if it doesn't fit the more specific virus, use the class of virus, if that makes sense.)

Thank you! Appreciate it very much