Medical Surveillance Monthly Report (MSMR). Volume 2, Number 5, May 1996
Abstract
A 2-year-11 month-old, previously healthy, girl residing in Fayetteville, North Carolina presented to Womack Army Medical Center (WAMC) on 5 February 1996 with a three-day history of lethargy, nausea, vomiting, dehydration, and fever up to 104?. She was responsive only to painful stimulus and showed little improvement with fluid resuscitation. Before admission she lived off-base with her older sibling, mother, and father, who is active-duty Army. Her admission physical revealed lymphadenopathy and nuchal rigidity but no evidence of upper respiratory symptoms, cough , or localized pain. Her white blood cell (WBC) count was 18,800/cu.mm with 85% segmented neutrophils and a serum sodium of 123 mg/dl. A lumbar puncture revealed 291 WBCs (82% segmented neutrophils, 18% lymphocytes), 63 RBCs, protein 159 mg/dl, glucose 29 mg/dl. Gram stain revealed a high number (2+) of Gram positive rods. She was treated with ceftriaxone (600 mg IV bid), decadron, and acyclovir. She was transferred to the pediatric intensive care unit at Duke University Hospital where she was intubated and hyperventilated because of increased intracranial pressure. A cranial CT scan revealed no evidence of an abscess, mass effect, cerebral edema, or herniation. When the CSF culture from WAMC grew Listeria monocytogenes, antibiotic therapy with ceftriaxone was discontinued and replaced with ampicillin (400mg/kg/ d in q 4h r), and gentamycin (7.5 mg/kg/day IV q 8hr). The hyponatremia, complicated by the syndrome of inappropriate anti-diuretic hormone secretion (SIADH), was handled with fluid restriction and resolved.
Document Details
- Document Type
- Technical Report
- Publication Date
- May 01, 1996
- Accession Number
- ADA497179
Entities
People
- Bruce H. Jones
- Cynthia R. Towle
- John Brundage
- Mark V Rubertone
- Sharon L. Ludwig
- Vincent P. Fonseca
Organizations
- Armed Forces Health Surveillance Center