Wednesday, January 11, 2006

Sick child with very painful legs - think meningitis

A sick child presents. Do they need:

1. a lumbar puncture?
2. blood cultures and observation?
3. blood cultures and IM antibiotics, f/u 24 hours?
4. treat as benign viral illness ...

BBC summarizes a Lancet article on early signs of meningitis. I'll have to look for more informative synopses of the article, but the 'unable to stand due to leg pain' sounds like it could be possibly distinctive enough to shift one's focus from blood culture only to culture and puncture. The circumoral pallor seems subtle (especially in non-Euros) and the cold hands and pale skin seem pretty nonspecific.

I just wonder how much that one relatively specific finding would really add by itself ...

1 comment:

JGF said...

I think the way you'd use this paper is pretty much what I meant. The presumption would be sick, feverish child with symmetric leg pain, unwilling to stand. So bacteremia with bad leg pain. The paper suggests adding an LP to whatever else one might do.

My original comment was kind of sketchy.