My area has recently seen 3 children at 2 separate facilities present with eerily similar and so far undiagnosed problems. Similar age group, but nothing else in common (different locations, ethnicities, no similar contacts or travels, etc.)
Presentation: 2-3 day history of fever, c/o headache, occasional vomiting. ER admission due to changes in level of consciousness or physical mobility.
Work-up: CT, MRI, LP, pan-cultures, viral panel of CSF, blood and secretions, standard lab work-up. All repeated after a few days of admission. Regular blood cultures. All results unremarkable. WBC's normal, CRP mildly elevated in 1-2 patients, CT and MRI normal, spinal fluid clear, cell count, protein, glucose results normal. All cultures and panels persistently negative.
Treatment: Broad-spectrum antibiotics and antivirals including max doses of vancomycin, ampicillin and acyclovir.
Course of stay: Progressive decline in neurological status. Most recent presenting patient deteriorated from oriented and physically appropriate to a GSC score of 6 within 8 hours. Seizures in the first 2 presenting patients. Loss of ability to maintain airway. Intubated for currently 2 weeks and 4 weeks respectively.
We are all at a loss. Does anyone have any insight?
Rabies? Any contact with animals (field trip? pets, are they vaccinated? any pets in fights with unknown other animals (infected saliva on fur even if pet is vaccinated)? anyone find a bunny/dead mice/squirrels/bat/raccoon in the yard??) should be followed up.
Sports teams? Did these kids all play on the same field? Drink out of the same water fountain?
Try the same magic pill-- you know how boys are-- parkinsonian symptoms? This sort of thing swept through the local addict population a few years back around here, turned out to be a contaminant in a recreational drug that fried the basal ganglia (permanently).
Bulbar paralysis is classic for polio-- immunizations recently?
One of my patients had excessive pulmonary bleeding, on oscillator, etc; improved when Drs figured out that valproic acid causes pulmonary bleeding...extremely RARE side effect...once patient was off the valproic acid and was switched to another anti-seizure med, she recovered. Immunology was involved; no immunologic deficit.
[ATTACH=CONFIG]12442[/ATTACH]A lot of mysterious diseases are popping up from over use of antibiotics. This is a photo of my niece. She has had cancer twice, (notice her arm) This is from the removal of a cancerous tumor located in her arm pit. Her throat is still very sore, and she has had numorous tumors removed from her body. None of us know where this disease came from. My brother and sister-in-law were both genetically tested and were negative for the neurofiborblastosis that ravages her body. She just turned 16.
Neurofibromatosis is a genetic disorder (autosomal dominant) that causes tumors to grow throughout the nervous system. It is not related to antibiotics at all. Fifty percent of cases are the result of a new genetic mutation and neither parent is affected. The other fifty percent are inherited from a parent with the disease.
OP, what state are you in? Any exposure to wildlife, pets, insects? What about the soil, water, etc -- could this be environmental? You've got us all so curious and I hope you'll be back to post the denoument!
A ten-year old boy presented with AMS in our ED today and all work-up was negative. He wasn't my patient, so I can't say what happened to him, although I believe he was admitted. Please let me know where you are located ASAP. You can message me. Thanks.
nurseprnRN, BSN, RN
1 Article; 5,116 Posts
Rabies? Any contact with animals (field trip? pets, are they vaccinated? any pets in fights with unknown other animals (infected saliva on fur even if pet is vaccinated)? anyone find a bunny/dead mice/squirrels/bat/raccoon in the yard??) should be followed up.
Sports teams? Did these kids all play on the same field? Drink out of the same water fountain?
Try the same magic pill-- you know how boys are-- parkinsonian symptoms? This sort of thing swept through the local addict population a few years back around here, turned out to be a contaminant in a recreational drug that fried the basal ganglia (permanently).
Bulbar paralysis is classic for polio-- immunizations recently?