We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Meningitis in the Child With a Smile-Reply

William B. Rogers, MD
Arch Pediatr Adolesc Med. 1995;149(10):1179. doi:10.1001/archpedi.1995.02170230133030.
Text Size: A A A
Published online


I agree with Dr Baptist's critique that a smile may not be a 100% accurate test to rule out meningitis in a febrile infant, but I hope no one thought I was failing to obtain a full history and results of a physical examination before deciding whether or not to initiate laboratory studies. My only contention is that in 45 years as a solo suburban pediatrician, I have never yet seen a febrile infant with meningitis who smiled.

However, what test ever is 100% accurate? Even results of an initial lumbar puncture that show CSF free of cells and normal results of chemistry studies do not rule out meningitis. I have examined a 3-month-old infant with purulent otitis media and suspicious meningeal signs whose initial CSF findings were normal, only to be told 12 hours later that the CSF culture was growing pneumococci.

I think Dr McCarthy's reply


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.