Expert Opinion :
This child has an encephalopathy (altered sensorium) with thrombocytopenia with normal sugar meningitis (all lymphocytes on CSF) with hepatosplenomegaly suggestive of a viral infection. CSF is not suggestive of bacterial infection. Though the child has neutrophilia on admission that could be due to seizure (Neutrophilia can occur post seizures due to stress). The CBC did normalize after 48 hours. Also CSF is normal in 48 hours. This is not commonly seen with bacterial meningitis. Thus, again viral meningoencephalitis is a possibility. In this child, the hemoglobin on admission was 9.4 gm% which has dropped to 6.3 gm% after 2 days. There is no bleeding or blood loss suggestive that the child had hemoconcentration initially. Also the child has slightly elevated liver transaminases with hypoalbuminemia and deranged prothrombin time and partial thromboplastin time with thrombocytopenia suggestive of infection with a virus leading to hemorrhagic fever. Thus one would consider a differential of dengue or kyasanur virus. In this child, Dengue IgM was positive suggesting a diagnosis of Dengue encephalitis.