MSRA-1200

A 30-year-old teacher who recently returned after completing a 3-month assignment in Thailand presented to the Emergency Department with fever, headache, confusion and vomiting in the last two days. She was suspected of having meningitis and underwent a lumbar puncture (LP). The LP findings are as follows:
Normal opening pressure, clear cerebrospinal fluid (CSF).
Investigation Result Normal value
CSF white blood cell count (WBC) 400 cells/µl, 70% lymphocytes < 5 cells/µl
CSF protein 0.5 g/l 0.15–0.4 g/l
CSF glucose 3.8 mmol/l 2.6–4.5 mmol/l
CSF–plasma-glucose ratio 0.72 ≥ 0.66
What is the most likely diagnosis?
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