Asymptomatic Viral Gastrointestinal Infection: The Missing Link?

Abstract

We present the case of an 8-month-old boy who presented with apparent life-threatening events later characterized as seizures in clusters. A total of 14 apneic episodes were observed within 24 hours before loading the patient with phenobarbital at which point the seizures stopped. There was no obvious explanation for his seizures. EEG revealed midline interictal discharges; MRI-head was normal; and all other investigations were normal. The patient' s stool was sent for virology with the clinical suspicion of benign infantile seizures associated with mild gastroenteritis (BISMG) despite lack of gastrointestinal symptoms. A small round virus was found. His clinical course followed the same progression as typical BISMG. This begs the question whether it is possible for virus in the stool to cause an asymptomatic gastrointestinal infection with its only clinical manifestation as seizures. We conclude that it may be possible for BISMG to present without gastrointestinal symptoms. As well, BISMG may be an unrecognized cause of apparent life-threatening events and should be considered in the differential diagnosis. Pediatrics 2014;133:e758-e761 AUTHORS:

Patient-Centered Medical Home Implementation in Indian Health Service Direct Service Facilities

“…While a key principle of PCMH is that team-based care can promote greater levels of patient engagement, one large study showed that only about one-quarter of practices with PCMH recognition included pharmacists, social workers, community service coordinators, and nutritionists on their care teams. 17…”

“…19 Some practices make a concerted effort to register patients on the practice's portal. 20 MAPCP providers often view their portals as time-saving and useful for interacting with patients, and patients also tend to value them.…”

“…Other practice staff might educate patients on the importance of avoiding the ED for nonurgent care. 24 Risk-stratified care management-in which the level of management is tailored to a patient's level of need or risk of adverse outcomes-is one of the most widely embraced strategies for improving patient care. 25 However, in the CPC initiative, it was a strategy that was pursued only in the later stages of implementation.…”

“…24 Risk-stratified care management-in which the level of management is tailored to a patient's level of need or risk of adverse outcomes-is one of the most widely embraced strategies for improving patient care. 25 However, in the CPC initiative, it was a strategy that was pursued only in the later stages of implementation. 26 Some advanced practices collect data on patients' family support and social service needs to help assign patients to risk categories.…”

“…26 Some advanced practices collect data on patients' family support and social service needs to help assign patients to risk categories. 27…”