The art of medicine is slowly being pushed out. Is that a good thing?

One late evening on pediatrics call, a frantic young couple brought in their few weeks old baby. She had spiked a fever which refused to go down and was fussier than normal. The cause of her symptoms could have been anything — at best, a mild respiratory infection, in which case we would simply watch her and manage her symptoms, but at worst, it could be meningitis, an infection attacking the membrane covering her spinal cord and brain. It’s a grave condition that would be fatal if left undiagnosed, but diagnosing it meant doing a lumbar puncture, an extremely invasive procedure for anyone, let alone a baby, involving inserting a needle into the spinal column. The situation was a classic dilemma: to tap or not to tap. After an hour of deliberation with the residents, I found myself holding down a writhing and crying infant by her legs and torso and while resident stuck a needle into her lumbar spine. After a few attempts, we finally drew enough spinal fluid for analysis. The next morning, the lab results came back — she didn’t have meningitis after all. Did we make the wrong decision by putting the baby and her parents through needless suffering and risk? When science fails to give us right answers, we’re forced to resort to our instincts, to dig deep into our clinical memory banks for guidance and have faith that our training was sufficient. And that ambiguity and nuance, as our attending at the time told us, capture the art of medicine and is w...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Education Mobile health Primary Care Source Type: blogs

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This study was conducted to assess the diagnostic value of CSF-CRP levels for differentiating between septic (bacterial) and aseptic infantile meningitis.Methods: 49 hospitalized infants aged less than two months with suspected meningitis were enrolled in a cross-sectional analytic study. All of patients underwent lumbar puncture to obtain CSF. smears, cultures, cytological and biochemical analysis and latex agglutination testing were carried out on all CSF samples. Latex agglutination test was carried out on all CSF samples using a commercially available kit. CSF-CRP level of all infants was measured using the immunoturbi...
Source: African Health Sciences - Category: African Health Source Type: research
AbstractPurpose of ReviewDefective cell –mediated immunity is a major risk factor for cryptococcosis, a fatal disease if untreated. Cryptococcal meningitis (CM), the main presentation of disseminated disease, occurs through hematogenous spread to the brain from primary pulmonary foci, facilitated by yeast virulence factors. We revisit r emarkable recent improvements in the prevention, diagnosis and management of CM.Recent FindingsCryptococcal antigen (CrAg), main capsular polysaccharide ofCryptococcus spp. is detectable in blood and cerebrospinal fluid of infected patients with point of care lateral flow assays. Rece...
Source: Current Neurology and Neuroscience Reports - Category: Neuroscience Source Type: research
This article reviews the clinical presentation, diagnosis, and treatment of neurosyphilis, and it addresses the controversy regarding the role of lumbar puncture early in the course of infection. [...] Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text
Source: Seminars in Neurology - Category: Neurology Authors: Tags: Review Article Source Type: research
Conclusion: Co-existing bacterial meningitis in febrile young infants with urinary tract infection is rare. In those meeting low-risk criteria, a lumbar puncture may not be indicated. A case by case assessment should be made in infants not meeting low-risk criteria.Trial registration: CRD42018105339What is known:•When caring for febrile infants ≤ 3 months with urinary tract infections, clinicians may have uncertainty on whether to perform a lumbar puncture (LP) for possible co-existing meningitisWhat is new:•An up-to-date systematic review of 20 studies found the frequency of co-existing meningitis...
Source: European Journal of Pediatrics - Category: Pediatrics Source Type: research
Meningitis can be caused by several viruses and bacteria. Identifying the causative pathogen as quickly as possible is crucial to initiate the most optimal therapy, as acute bacterial meningitis is associated ...
Source: Journal of Translational Medicine - Category: Research Authors: Tags: Research Source Type: research
Lenggenhager Cordey Kaiser : Meningitis, encephalitis, and myelitis are various forms of acute central nervous system (CNS) inflammation, which can coexist and lead to serious sequelae. Known aetiologies include infections and immune-mediated processes. Despite advances in clinical microbiology over the past decades, the cause of acute CNS inflammation remains unknown in approximately 50% of cases. High-throughput sequencing was performed to search for viral sequences in cerebrospinal fluid (CSF) samples collected from 26 patients considered to have acute CNS inflammation of unknown origin, and 10 patients wit...
Source: Genes - Category: Genetics & Stem Cells Authors: Tags: Article Source Type: research
Publication date: Available online 16 August 2019Source: Journal of Clinical NeuroscienceAuthor(s): A. Skalnaya, V. Fominykh, R. Ivashchenko, D. Averchenkov, L. Grazhdantseva, N. Frigo, E. Negasheva, O. Dolya, L. Brylev, A. GuekhtAbstractThe term of neurosyphilis (NS) refers to infection of central nervous system by Treponema pallidum. Classically, it has been divided into early (meningitis, meningovascular) and late forms (general paresis and tabes dorsalis). The availability of penicillin and high sensitivity of Treponema pallidum to this antibiotic has led to a widely held perception about rarity of syphilitic forms wit...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research
Definitive diagnosis of meningitis is made by analysis of cerebrospinal fluid (CSF) culture or polymerase chain reaction (PCR) obtained from a lumbar puncture (LP), which may take days. A timelier diagnostic c...
Source: BMC Infectious Diseases - Category: Infectious Diseases Authors: Tags: Research article Source Type: research
Conclusions Fungal sinusitis is uncommon, especially in those without significantly compromised immune systems. Invasive fungal meningitis resulting in meningitis and encephalitis is even rarer. The condition carries high morbidity and mortality that can only be mitigated with a multidisciplinary effort by neurosurgery, otolaryngology, and infectious disease specialists. While there are no clear treatment guidelines, we present an approach that may permit longer term independent survival. [...] Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abst...
Source: Journal of Neurological Surgery Reports - Category: Neurosurgery Authors: Tags: Case Report Source Type: research
Conclusion: Concurrent infection with cryptococcosis and MAC is extremely rare even in immunosuppressed patients. In our case, the concurrent infection was associated with a prolonged course of therapy during the induction phase for cryptococcosis. PMID: 31258430 [PubMed]
Source: Ochsner Journal - Category: General Medicine Tags: Ochsner J Source Type: research
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