20. Making a List and Checking it Twice

  1. James C. Pile4,
  2. Thomas E. Baudendistel5 and
  3. Brian J. Harte6
  1. Satyen Nichani1,
  2. Sandro Cinti2 and
  3. Jeffrey H. Barsuk3

Published Online: 21 MAR 2013

DOI: 10.1002/9781118483206.ch20

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine

How to Cite

Nichani, S., Cinti, S. and Barsuk, J. H. (2013) Making a List and Checking it Twice, in Clinical Care Conundrums: Challenging Diagnoses in Hospital Medicine (eds J. C. Pile, T. E. Baudendistel and B. J. Harte), John Wiley & Sons, Inc., Hoboken, NJ, USA. doi: 10.1002/9781118483206.ch20

Editor Information

  1. 4

    Departments of Hospital Medicine and Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA

  2. 5

    Department of Medicine, Kaiser Permanente Medical Center, Oakland, California, USA

  3. 6

    South Pointe Hospital, Cleveland Clinic Health System, Warrensville Heights, Ohio, USA

Author Information

  1. 1

    Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

  2. 2

    Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

  3. 3

    Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

Publication History

  1. Published Online: 21 MAR 2013
  2. Published Print: 15 MAR 2013

Book Series:

  1. Hospital Medicine: Current Concepts

Book Series Editors:

  1. Scott A. Flanders and
  2. Sanjay Saint

ISBN Information

Print ISBN: 9780470905654

Online ISBN: 9781118483206

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Keywords:

  • diagnosis;
  • human ehrlichiosis (HE);
  • infection;
  • leptospirosis;
  • serologic tests

Summary

Serologic tests are often used to establish the diagnosis of leptospirosis and ehrlichiosis. Establishing a diagnosis of leptospirosis is challenging and requires a high index of suspicion. Clinicians should be aware of the limitations of the diagnostic accuracy of the serologic assays for leptospirosis because they are frequently negative in the first week after symptom onset. The classic finding of conjunctival suffusion is helpful in differentiating leptospirosis from human ehrlichiosis (HE). The case study discussed in the chapter highlights the importance of the clinical practice of making a list of suspected diagnoses, remaining open to these possibilities, and checking serologic tests again in convalescence to confirm the diagnosis.