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Re: Another case from MalcolmFrom: Malcolm Griffiths (malcolm@mgriff22.demon.co.uk)Fri Jul 4 17:45:22 1997
In message <33BC3390.35ECAA06@saidi.prestel.co.uk>, Samir Saidi <sam@saidi.prestel.co.uk> writes >We're entering the rarer realms of the hepatitides I think.
Gosh this guy is persistent !
>
I asked for a diagnosis - this is wider than a differential ! I think
though you may have something here !
> I am offended by the mere suggestion ;-) No I haven't hidden anything. Largely I'm trying to reproduce the conditionsas I experienced them. Saturday evening last week, I contact my microbiology consultant colleague. Said I thought I had a woman with acute viral hepatitis. The hepatis has been quite mild. Only in a good light has she ever looked jaundiced. My differential was HepA or B ( microbiologist was worried about C,E, ... Z ! I wondered about Epstein-Barr, my wife ( remember she's am FP ) said E-B was likeliest. Other choice was CMV. The other possibility we considered was cholestasis + other bacterial infection. MSU was clear. Blood cultures grew a fairly benign skin staph - contaminant ? My major issue was that if the cause was acute hepB, that the baby would need fairly prompt active AND passive hepB immunisation. We actually delayed the CS until we were certain we'd have hepB status of mother within 2 hours of delivery. We confirmed all staff involved were hepB immune and did CS. Shortly afterwards serology was negative for hep A, hepB, monospot was negative, but positive for CMV. Transaminases peaked on Sunday/Monday and have steadily declined since then mother was slightly confused and verging on hallucinations on Monday. She went home today ( 1 week in hospital ). Gastroenterology advice is no precautions except weatch LFTs go back to normal. Microbiologists have restested serum - results awaited - and sent samples to national reference lab.
>PS: Passing by Luton tomorrow - maybe I should nip in to labour ward and Why just pass Luton ? I'm sure all the staff would maintain confidentiality. As staf largely alternate weekends, there'd be no-one around who saw her ! VERDICT: Samir wins, but only because he gave a very wide differential ! Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp., LU6 2DT, UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "It is dangerous to be right on a subject on which the established authorities are wrong." (Voltaire) "But sometimes it's fun :-)" (Griffiths)
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