Abstract Introduction During COVID-19 surges, many patients present with viral-like syndromes, increasing the risk of diagnostic anchoring on a viral etiology. New host-response tests have the potential to help with early identification of bacterial infections. MeMed BV is an FDA-cleared test that measures the immune response to differentiate bacterial from viral or non-infectious causes of suspected acute illness. Description of case Chief complaint: Fever and body aches for 3 days.History of Present Illness: A woman in her 40s, a healthcare worker, presented to the ED with 3 days of intermittent fevers (Tmax 104 °F) and generalized body aches. She reported new right upper back discomfort worsened by deep breathing, with mild congestion and headache one day prior. She denied chest pain, shortness of breath, abdominal pain, nausea, vomiting, diarrhea, dysuria, urinary frequency or flank pain. Fatigued after a long shift, she expressed a desire to go homePertinent Physical Exam: Vital signs at triage: HR 108, BP 123/60, T 98.2 °F, SpO2 97% RA. On exam, patient appeared uncomfortable but not toxic. No respiratory distress; lungs clear. Abdomen soft, non-tender. No CVA tenderness.Pertinent Laboratory Data: WBC 9K, platelets 142, lactate 2.3, mild transaminitis. Tbili 2.0. UA: WBC 46, few bacteria. Chest X-ray negative. Viral panel negative. MeMed BV (Host-response essay): Score 100, “High likelihood of bacterial infection (or co infection).” Discussion This patient’s nonspecific symptoms, normal lung exam, negative chest X-ray, and negative viral panel favored a viral illness, and she requested discharge. At 10:00 pm, a MeMed BV test was ordered, and by 11:00 pm it returned a score of 100: “High likelihood of bacterial infection (or co-infection).” Its bacterial result prompted the clinician to retain the patient for observation and re-examination rather than discharge. Within one hour, the patient developed hypotension (BP 92/49, then 80s/40s) with tachycardia, rapidly declaring herself septic. Broad-spectrum antibiotics, cultures, IV fluids, and vasopressors were initiated. A CT abdomen/pelvis revealed acute left-sided pyelonephritis, and blood and urine cultures later grew E. coli. She was admitted to the MICU for septic shock management, stabilized on day 2, and discharged home on day 3.Notably, traditional biomarkers (WBC 9K, lactate 2.3, mild transaminitis) were nonspecific and did not indicate severe bacterial infection at presentation. The BV assay provided actionable information that standard labs could not, directly altering the patient’s trajectory, without it, the patient might have been discharged prior to her deterioration, delaying recognition of life-threatening sepsis. This abstract is funded by: None
Mann et al. (Fri,) studied this question.