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Monday, January 31, 2011

Strep Throat vs. Spinal Meningitis

 Once when I was in the fourth grade I had a fever, headache, nausea and I felt lousy. My mom tried to get me to touch my chin to my chest. I couldn't/wouldn't. My mom rushed me to the emergency room because she was sure that I had spinal meningitis. As it turns I wouldn't touch my chin to my chest because I had a nasty case of strep throat. It hurt too much. Now it was great that she took me to the doctor, but it didn't really didn't merit an ER visit. (Of course I don't remember what day or time it was, that may have been the only option.) Complications of untreated Strep can include scarlet fever, rheumatic fever, and glomerulonephritis, but those are less likely to happen if antibiotics are started in a timely manner (and don't forget to take the whole course of antibiotics, not just until the symptoms go away.)
  It was years later when I was in nursing school that I realized what my mom was looking for. She was looking for a positive Brudzinski's sign, however it isn't based on whether a child can voluntarily touch their chin to their chest. To test for Brudzinski's sign, have a child lay flat on their back on a firm surface. (A floor or table will work.) Then firmly push their chin to chest. A positive sign will result in their legs and hips flexing involuntarily. If you see this, I would recommend taking your child to the emergency room, pronto. (Of course, you may be ok, going to a clinic first, if you can get in quickly and are admitted from there. Sometimes that's faster than going through the ER (and generally significantly less expensive). Where you should go to depends on where you live, how far the hospital is from you and your average ER wait times. But don't deliberate about the matter for too long.) The point is that this is serious business. Not to say that a negative Brudzinski's sign rules out a diagnosis of spinal meningitis, because it doesn't. But a positive Brudzinski's will not be seen in any other disease.
Symptoms of spinal meningitis include headache, fever, nausea, vomiting, irritability and lethargy. (See how the two can be confused?) Although the symptoms in meningitis are often more extreme than what will be seen in strep throat and also sometimes include muscle rigidity, bulging soft spots in infants, cold extremities and abnormal skin color. Of course you don't need all of these symptoms to have spinal meningitis. Small children sometimes only have fever and irritability, which can make a "phone or internet diagnosis" difficult. The surest way to diagnose spinal meningitis is with a lumbar puncture or spinal tap. I know that sounds really scary to a parent, to think about multiple people holding your child down while a doctor puts large needles into your child's spine, but if there is a chance that your child has this disease, you need to know. Not only that, you need to know what is causing it, whether it be bacteria or virus and what kind, so the doctor can pick the most effective medication.
 Meningitis is an inflammation of the meninges, which are the protective coverings of the brain and spinal cord. If those tissues become infected, because of their location, it can lead to serious problems. Complications can include permanent brain damage, deafness, epilepsy (a seizure disorder), sepsis (wide spread systemic infection), gangrene of limbs, shock and death. Does this mean that if your child has meningitis that they are going to die or have these complications? No. I have cared for many, many kids with this diagnosis, and I have never seen one die and I can list on one hand the kids I have seen who have had serious complications. But if your child does not get immediate treatment, their risk greatly increases. Bottom line, if you remotely suspect that your child has spinal meningitis, get it checked out as soon as possible.

1 comment:

  1. We had a few elders get spinal meningitis on my mission and they only way they could diagnosis it at the local hospital was with the chin to chest test (such is the third world). Thank you for explaining the rest of that test. It's definitely a scary disease and one to know about.