Is it possible that the bacteremia may have cleared spontaneously if you had
not treated with Vit R?
Also, how come no CXR when the WBC was 18K?.
From: Marc Leder <[log in to unmask]>
To: Jravner <[log in to unmask]>
Date: Friday, April 24, 1998 2:15 PM
Subject: Re: Fever, URI, OB
>I too am very supportive of excellent clinical judgement in managing
>patients however when this term is applied to "occult bacteremia" what
>exactly do you mean? Doesn't the term occult bacteremia imply that just
>by taking a history and doing a physical exam you can not separate those
>who may be bacteremic from those who are not. How do you decide then who
>to do lab work on and who not to do it on if an ill appearing child may
>be bacteremic but so can a "non-toxic" appearing child.
> Quick personnal vignette- 18 month old with temp to 39 degrees
>source. Child looks GREAT!!!Playing in chair/smiling/happy. I elect to
>do a CBC, cath UA/c&s,and a Blood culture. White blood cell count
>returns at 18,000. I elect to treat with IM ceftriaxone. I discharge
>patient with good followup. 16 hours later the blood culture is growing
>Neisseria meningitidis! I now call the patient back in for admission, IV
>antibiotics,LP. Repeat blood culture on return visit status post
>ceftriaxone X 1 is no growth. Child does great with no sequelae. I think
>I managed this patient very well. Would I have diagnosed this bacteremia
>if I had not done the work up initially? Would the child have become
>septic and then be diagnosed? All I know is that myself, my collegues
>and the patients primary care physician were quite grateful that this
>diagnosis was made when it was made and not later when the child could
>have been much sicker with meningococcemia and full blown sepsis.
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