I am curious why retapping could NEVER be an option. I think it has a place
in select cases. As you know, many viral meningitis's have an initial
polymorphonuclear response. For example, if his tap had 1000 cells, 80%
polys, normal glucose-protein-gram stain & looked well post tap, I may be
reluctant to send someone like him home right off. Yet, I may not want to
commit him to 72 hours of IV abx (including vancomycin) and hospitalization
till cultures are sterile when the epidemiology, clinical picture and CSF
point to a viral etiology.....
The controversy Dr Scarfone, I believe, will soon end by the turn of the
century when PCR for enterovirus is available from the ED (with a couple of
hours turnaround) !!! Actually, I think San Diego Children's has this
available right now. May be someone from UCSD could comment on this.
Here at UAB we have the world renowned herpes research group. If I suspect
HSV they can run a courtesy CSF PCR for HSV ASAP and give us reliable
results in a few hours. This is a luxury that we are spoilt with but can be
a huge help with a say a sick/"septic" neonate.
Jay Pershad, M.D.
"We care for wee folks"
> -----Original Message-----
> From: David Soglin [SMTP:[log in to unmask]]
> I would definitely do an LP on the patient that was described. I want
> to know if in fact the kid does have viral meningitis - even if I am
> certain he does not have bacterial meningitis, he could have a
> subarachnoid or other explanation for his fever, lethargy and increasing
> headache. I want to have a diagnosis in mind.
> If the LP was clearly pointing to viral meningitis as the etiology, I am
> comfortable letting him go home with good follow-up. I never keep them
> and retap - if I am not sure after the initial LP - I want them admitted
> with the antibiotics going.
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