A nine-month old previously healthy male presents with a 30 hour history of fever and irritability. His parents state that the patient is more somnolent, but fusses continuously when he is awake. The infant is feeding poorly and has been spitting up for the last few hours.

Vital signs in the ER reveal: T 102.5 f, P 145, RR 24, BP 90/60. Physical exam reveals an ill-appearing infant with obvious nuchal rigidity.

1) List 3 possible diagnosis

2) Is there any other additional history that would be helpful and why?

3) What other physical findings might you expect in a child with this problem and why?

4) What laboratory and/or radiologic studies would be helpful and why?

5) Discuss various infectious agents associated with your differential diagnosis.

6) Cite a recent (non-website) pediatric reference to support your responses.