Lest we get too comfortable please see BMJ 1998;316:1887-1889 ( 20 June )
In this issue two cases of bacterial meningitis are presented.. The initial
CSFG was essentially normal. ( the protein was up some)
Even though we no longer run into the same problems with hemotogenous
infections from H.flu, Strep pneumo, does present very real concerns and as
these authors point out, may not present with textbook findings..
Just some food for thought...
I personally will tap all suspected of meningitis, admit the younger ones
definitely..If I do not think treatment is indicated I will try to discern
whether the parents and follow up are reliable. and if so, discharge if not
In J Pershads scenario of the patient with what appears to be clinical
aseptic disease but a CSF with PMNS, I usually admit and treat though
retapping later is an option, I leave that up to the floor team/attending, I
am more comfortable initiating therapy in those questionable cases.
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