Complaints Related to the Head

  • I. W. FongEmail author
Part of the Emerging Infectious Diseases of the 21st Century book series (EIDC)


A 16-month-old male child was taken to a community based emergency department by the mother at about 3 a.m. The child had been unwell the evening before with fever, vomiting, restlessness and irritability. The emergency physician evaluation 30 min later noted a temperature of 39°C, a pulse of 140/min, respiratory rate of 34/min, but there was no recorded blood pressure. According to the transcripts, the clinician felt the infant was not dehydrated, and the examinations of the ears, throat, chest, and abdomen were recorded as normal. A complete blood count was ordered, which revealed a hemoglobin of 91 g/dL, and a total normal white blood count (WBC) of about 9,000/μL. However, the differential count was not available until 3 h later. The child was treated with acetaminophen, which resulted in a reduction of the temperature later to 37.9°C, and he was also reassessed by the attending physician 2 h later (but not recorded in the chart), with apparently no worsening. The child was then discharged after 6 a.m., and the mother reassured that her son had only a “flu-like” illness. The leucocyte differential court subsequently was reported as showing 22% bands (normal 3–5% for a young child), but the family was never notified.


Lumbar Puncture Bacterial Meningitis Acute Otitis Medium Pneumococcal Meningitis Neck Stiffness 
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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.St. Michael’s HospitalUniversity of TorontoTorontoCanada

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