First, I am inclined to agree with those who advocate outpatient management
of the presumable viral meningitic.. The caveats to me are:
1. must appear well,
2. all labs must be consistent with viral illness
3. no underlying risks,, ie immunocompromise, shunts/hardware,
4. reliable parents, good follow up
5. a meticulous system for culture follow up
6. a viable phone number to get the patient back in the event of a culture
that changes your management choice.
I also disagree that patients are sent home with meningitis that are not
tapped.( how would you know they have meningitis??) I do agree patients are
sent home with the clinical signs and symptoms of meningitis but if they are
not tapped we really dont know they had it, do we?
As for not tapping.. well that's your clinical judgment isn't;t it??
I do tap patients with severe headaches, fever and vomiting,, even if I
choose to discharge to home management, I like to be able to give the family
a firm diagnosis and can prognosticate more accurately with better data..
Further more as Jay Pershad has mentioned.. there are other diseases that
look like viral meningitis and yet may be much more serious...
Although rare pseudotumor cerebri may also present in this fashion . This
condition may cause blindness if not treated and hence not tapping the
headache patient could be harmful..
Last,, and I apologize for being so long winded...
Hemmers cases of doom and gloom sound like they were mismanaged in the first
place..Those kids sound like missed meningitis on initial presentation and
not "viral meningitis" that became bacterial..Since they were not tapped
does any one still argue that tapping is not a good idea?) we are left to
speculate as to whether they might have had a bacterial disease ..
JMHT ( just my humble thoughts)
begin 666 Martin I. Herman.vcf
M-3 R-0T*0412.U=/4DLZ.SDP,2 U-S(@,S Q,#L[365M<&AI<SM43CLS.#$P
M-S(@,S Q,#TP1#TP04UE;7!H:7,L(%1.(#,X,3 S#0I%34%)3#M04D5&.TE.
M5$523D54.F%M86YT97- <')O9&EG>2YN970-"E)%5CHQ.3DX,#@R,U0R,C W
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: