jen0508 Posted September 25, 2014 Share Posted September 25, 2014 Had a 20-something y/o male the other day with URI symptoms (congestion, sore throat, cough), on ROS he said yes to nearly everything, including head and neck pain(pointing to lateral neck as opposed to posterior neck). Normal vitals (no fever), appeared well and nontoxic, no real nuchal rigidity but did complain of neck pain with brudzinski's but otherwise brudzinski's and kernig's were negative. minimally elevated white count. I was very on the fence about doing LP on this patient, but for some reason ended up tapping him CSF studies all normal (protein, glucose, cell count & diff, antigen panel, gram stain). He did receive rocephin IV as CSF labs were cooking. When everything on CSF analysis was (-) he was d/c. The next day found out his CSF culture was positive with gram + cocci, he was immediately called back to the ED and admitted Have any of you every encountered this? Normal CSF studies and negative gram stain, well appearing patient...with eventual (+) CSF culture? I am wondering if this could possibly have been a (+) culture from contamination? If this was a true positive culture and this person has meningitis, this is very scary to me as I see patients like this all the time (well appearing patient with URI symptoms with complaints of headache/vague neck pain and unremarkable exam). I rarely LP people, now I'm thinking I need to have a lower threshold Link to comment Share on other sites More sharing options...
mlsclm Posted September 25, 2014 Share Posted September 25, 2014 Curious, what was the organism? Are we talking pnemococcal or a CNS? Link to comment Share on other sites More sharing options...
jmj11 Posted September 25, 2014 Share Posted September 25, 2014 Never seen it without WBCs or other indicators in the spinal fluid. Strange one. Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 25, 2014 Share Posted September 25, 2014 Had a SP about 20 years ago with young college-aged student. Negative CSF but just KNEW she had meningitis. Let her go. Comes back in next day dead. Link to comment Share on other sites More sharing options...
mlsclm Posted September 25, 2014 Share Posted September 25, 2014 Jeez. That would keep me up for many nights Link to comment Share on other sites More sharing options...
primadonna22274 Posted September 26, 2014 Share Posted September 26, 2014 Tough one since you don't have a control for CSF (what about the blood cultures?) Nobody would want to take the risk to NOT treat a positive CSF culture so the hospitalization and IV antibiotics is a no-brainer...however, a negative gram stain and neg CSF studies just doesn't add up. I suppose if it was a SUPER DUPER EARLY bacterial meningitis and the culture grew bacteria right about the time patient would have been much worse, then it's interesting...but moot point since he had already been partially treated with CTX (good on you). Just out of curiosity, did the patient look or feel worse the next day when called back to the hospital? Link to comment Share on other sites More sharing options...
jen0508 Posted September 29, 2014 Author Share Posted September 29, 2014 Mystery solved -- according to hospitalist note on EMR, patient was discharged the next day. The note states culture was determined to be a contaminant and it was a "false alert." Not sure how that happened however he was discharged Link to comment Share on other sites More sharing options...
jmj11 Posted September 29, 2014 Share Posted September 29, 2014 Mystery solved -- according to hospitalist note on EMR, patient was discharged the next day. The note states culture was determined to be a contaminant and it was a "false alert." Not sure how that happened however he was discharged That's what I was thinking. With no CSF leukocytosis it wasn't adding up. Link to comment Share on other sites More sharing options...
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