Luke
Fever and diarrhea aren’t exactly unusual in infants. Often, these symptoms are simply evidence of newborns adjusting to the word outside the womb. But for baby Luke,* these symptoms were the sign of a much more serious health issue: Salmonella.
Baby Luke wasn’t sleeping. He was irritable and lethargic. He refused to eat. When his parents held him, he railed against the lightest touch – his neck and head were tender and painful. At first, his parents figured they were dealing with a colic-y baby. But when they had trouble awakening Luke from sleep, they knew something was wrong.
Luke’s parents brought him to the Lifespan Academic Medical Center in Providence, RI, where doctors admitted him into the pediatric ICU. Luke’s fever was high and growing, and he was experiencing severe gastrointestinal symptoms. All signs were pointing to infection, a potentially dangerous diagnosis in infants, as their immune systems aren’t fully developed to fight back.
Doctors suspected viral meningitis, a condition that causes inflammation in the lining covering the brain and spinal cord. Babies can contract viruses that cause meningitis from their mothers during birth or from contact with infected people.
Luke’s doctors knew they needed to act quickly: meningitis can be fatal in babies or can cause permanent hearing problems, learning disabilities, seizures and paralysis. They prescribed an antiviral therapy along with broad-spectrum antibiotics, in case the meningitis was bacterial instead.
To determine the pathogen causing the meningitis – whether flu, HSV, chickenpox, measles and mumps, or some other virus – doctors performed a lumbar puncture, also known as a spinal tap. During a lumbar puncture, a doctor inserts a needle between a patient’s vertebrae to retrieve a sample of cerebral spinal fluid for diagnostic testing. Doctors also sent samples of Luke’s blood to the lab for standard clinical testing.
Within a few hours, doctors reviewed Luke’s blood cultures and testing results. They didn’t back up a viral meningitis diagnosis – instead they hinted at a bacterial meningitis diagnosis. Doctors needed the results from the cerebral spinal fluid testing ASAP. Luke’s cerebral spinal fluid was loaded onto a sample card for analysis.
Standard laboratory analysis of cerebral spinal fluid takes 24-48 hours. But amid growing concerns that Luke could spiral into sepsis – a potentially fatal condition that occurs when chemicals in the bloodstream released by the body to fight infection trigger dangerous inflammation throughout the body – doctors opted for a unique rapid diagnostic.
Laboratory analysts used a Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF) system to identify the bacteria causing Luke’s illness. MALDO-TOF is a new molecular diagnostic tool that can detect even trace amounts of bacteria, fungi, molds and other agents. The process is quick and economical, meaning microbiologists can deliver determinations almost immediately.
In Luke’s case, the microbiologist’s determination was completely unexpected. The bacteria hurting Luke was Salmonella, a bacterium most often associated with contaminated food. Since 4-week-old Luke was not yet eating solid foods, doctors had not once considered Salmonella. Little did they know, Luke had a pet lizard at home, exposing him to reptile-associated salmonellosis. Not to mention, Salmonella meningitis is extremely rare, causing only 0.3% of bacterial meningitis cases in infants. Without an intelligent diagnostic, doctors may have never discovered Luke’s root problem.
Equipped with an accurate diagnosis, Luke’s doctors replaced his antiviral therapy and broad-spectrum antibiotics with a targeted antibiotic IV bundle. Within a few hours, Luke began to recover. Within the week, Luke was back home, healthy and happy.
Luke’s story underscores the importance of innovative diagnostic testing in the hospital setting and beyond. Diagnostics provide critical health care information that directs optimal treatment and saves people’s lives. For more information on the value of diagnostics.
*Name has been changed for privacy.