Thanks for all the replies to date
Obviously there was a reason for posting this case. I described the
first presentation of this child and on this occasion she had a UA
and culture - both of which turned out to be normal.
Her fever persisted and she returned to her family doctor 2 days
later and was put on ceclor - apparently was still well with no focus.
A further 4 days later she returned to the ED with ongoing fever -
she was still very well and had no focus (now 10 days into the
illness). At no time was there any sign for kawasaki's disease other
than the fever. At this visit the antibiotic were ceased, she was
observed for 12 hours and sent home.
Obviously I would ask what you would do at this point. In the
interest of not causing further chest pain to those reading I will
finish the story.
She returned a further 3 days later with ongoing fever (now off a/b
for 4 days). she was occasionally complaining of not feeling well but
looked well and was eating junk food in the ED
FBE - WCC 15, CRP >250 other bloods ok, bl cult -ve
Admitted for observation
LP done 12 hours later (as she had deteriorated on the ward)
confirmed pneumococcal meningitis. Child became very unwell - ICU
stay needed - but eventually got home.
This has raised for us the question of when to investigate for
partially treated meningitis, when to investigate persistent fever in
kids on antibiotics.
Of the 24 replies - to the list and directly to me - only one would
have tapped her at the first visit. I agree this is a common
presentation but should we have tapped on the second visit??
Thanks again in anticipation of your replies to help us determine
what to do in future such cases
Paediatric Emergency Physician
Department of Emergency Medicine
Royal Children's Hospital,
Parkville Victoria 3052
Tel: +61 3 9345-6592
Fax: +61 3 9345-5938
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