Posted By: Mark Crislip, Infectious Diseases, Jul 15, 2009
http://boards.medscape.com/forums?128@399.ySKYaarybp4@.29f4d173!comment=1
|
Vacation means swimming. In the lakes. In rivers. In oceans. In
pools. When you swim in a pool, you are swimming in the microbial
flora of everyone else in the pool because chlorine does not kill
everything.
The family had returned from a 2 week trip to the tropics where they swan with many a young child in the hotel pool. First one child gets sick with nausea, vomiting and headache. Then the next child gets nausea, vomiting and a headache. Dad gets lip blisters. Mom then gets nausea, vomiting and a headache. She goes to the ER and has an LP. Me? I am never going to use the word 'headache' in an ER. I do not want an LP. The thought gives me the willy s. She had a classic aseptic/viral meningitis and went home after a few days. Then she has progressive shortness of breath and gets admitted to my hospital with large, bilateral pleural effusions, prolonged PR on EKG, but normal cardiac function. I was called. Sound of trumpets announcing my arrival. I was betting on
leptospirosis more than the eventual diagnosis because of the
pleural effusions. Their tropical travels had taken them to areas
that were endemic with leptospirosis and it is a common cause of
aseptic meningitis if you look for it. There were other features
against lepto: no protein in the urine, no increase in bili, no
conjunctival suffusion. |