CASE 57
A 3-week-old baby boy was brought to the emergency department with a 24-hour history of fever, poor feeding, irritability, and a seizure that occurred just before arriving at the ED.
LABORATORY STUDIES
Diagnostic Work-Up
Table 57-1 lists the likely causes of illness (differential diagnosis). Lumbar puncture can be performed if the patient does not have papilledema or lateralizing neurologic findings. Bacterial or viral cultures from the mother may provide valuable information. Investigational approach may include
TABLE 57-1 Differential Diagnosis and Rationale for Inclusion (consideration)
Rationale: In infants younger than 1 month, there are relatively few common causes of meningitis. E. coli, S. agalactiae, and S. pneumoniae are the most common agents in infants; the remaining are much more common in adults. The viral causes are also less common, and sepsis in general would not be expected to typically cause seizures, although sepsis is much more common than meningitis. The other congenital infections usually do not manifest with such severity.
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