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Tascini C, Iantomasi R, Sbrana F, Carrieri C, D'Angela D, Cocchio S, Polistena B, Spandonaro F, Montuori EA, Baldo V. MAGLIO study: epideMiological Analysis on invasive meninGococcaL disease in Italy: fOcus on hospitalization from 2015 to 2019. Intern Emerg Med 2023; 18:1961-1969. [PMID: 37528328 PMCID: PMC10543787 DOI: 10.1007/s11739-023-03377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/26/2023] [Indexed: 08/03/2023]
Abstract
This study analyzed hospital admissions for invasive meningococcal disease (IMD) in epidemiological and economic terms in Italy from 2015 to 2019. The volume of acute admissions for meningococcal diagnosis was analyzed in the period from 2015 to 2019. IMD admissions were identified by ICD-9-CM diagnoses. Costs were assessed using current DRG tariffs. In 2019, a total of 237 admissions for meningococcal disease were recorded in Italy. The mean age of patients was 36.1 years. Lumbar puncture was reported in only 14% of hospital discharge forms. From 2015 to 2019, there was a mean annual reduction of - 1.2% nationally for IMD hospitalizations. For 2019, the total costs for acute inpatient admissions were €2,001,093. Considering annual incidence due to IMD, a significant decrease was noted in the age group from 0 to 1 year (p = 0.010) during 2015-2019. For all years, mortality associated with meningeal syndrome was lower compared to septic shock with or without meningitis. From 2015 to 2019, hospitalizations for IMD appear to be decreasing slightly in Italy, even if mortality remains high. Favorable trends in hospitalizations for IMD were seen in the 0-1-year age group, which may be attributable to increased vaccination. Costs of hospitalizations for IMD remain high.
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Affiliation(s)
- Carlo Tascini
- U.O. Malattie Infettive, Dipartimento di Medicina dell'Università di Udine, Università di Udine e Azienda Sanitaria Universitaria Integrata di Udine, Via Pozzuolo, 330, 33100, Udine, Italy.
| | | | - Francesco Sbrana
- U.O. Lipoapheresis and Center for Inherited Dyslipidemias, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ciro Carrieri
- C.R.E.A. Sanità e Università di Roma Tor Vergata, Rome, Italy
| | | | - Silvia Cocchio
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Leonardo Loredan 18, 35131, Padua, Italy
| | | | | | | | - Vincenzo Baldo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Public Health Section, University of Padua, Via Leonardo Loredan 18, 35131, Padua, Italy
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2
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Pearce J, Peters M, May N, Marshall H, Hein C, Grantham H. Care of the patient with invasive meningococcal disease by prehospital emergency medical service clinicians: a scoping review. BMJ Open 2020; 10:e033447. [PMID: 32114468 PMCID: PMC7050377 DOI: 10.1136/bmjopen-2019-033447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/12/2019] [Accepted: 02/12/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The objective of this scoping review is to systematically map the literature to identify the scope, depth, key concepts and gaps in the evidence regarding care of the patient with invasive meningococcal disease by emergency medical service (EMS) clinicians. DESIGN Scoping review. This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guideline. ELIGIBILITY CRITERIA Sources which focused on patients with invasive meningococcal disease (population), where the care of EMS clinicians was the focus (concept), in EMS systems worldwide (context) were eligible for inclusion. SEARCH STRATEGY This review utilised a comprehensive search strategy including MEDLINE, Embase, Emcare, CINAHL, Scopus, Web of Science, Google Scholar and 'grey' literature databases from 1992 to January 2019. The search also included a Google search, a hand-search of relevant journals, screening of reference lists, contact with authors of included sources and use of social media in an attempt to locate all sources of evidence which fit the inclusion criteria of the review. Two reviewers independently screened sources for inclusion. RESULTS The search yielded 1803 unique records, of which 10 were included in the synthesis. No original research papers were identified, with all sources classed as either clinical audit or text and opinion literature. The dominant concept throughout the literature is that early antibiotic therapy is critical in the treatment of invasive meningococcal disease. CONCLUSIONS Overall, there is a very narrow scope and shallow depth of literature on the topic of interest. There are gaps in the evidence regarding the care of the patient with invasive meningococcal disease by EMS clinicians. Despite these shortfalls, current consensus-based guidelines should direct clinical practice. Further research is planned to bridge the gaps in knowledge to support best practice.
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Affiliation(s)
- James Pearce
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- South Australian Ambulance Service, Adelaide, South Australia, Australia
| | - Micah Peters
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Nikki May
- SA Health Library Service, Bedford Park, South Australia, Australia
| | - Helen Marshall
- School of Medicine and Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Vaccinology and Immunology Research Trials Unit, Discipline of Paediatrics, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Cindy Hein
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- South Australian Ambulance Service, Adelaide, South Australia, Australia
| | - Hugh Grantham
- South Australian Ambulance Service, Adelaide, South Australia, Australia
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Boccalini S, Bechini A, Sartor G, Paolini D, Innocenti M, Bonanni P, Panatto D, Lai PL, Zangrillo F, Marchini F, Lecini E, Iovine M, Amicizia D, Landa P. [Health Technology Assessment of meningococcal B vaccine (Trumenba ®) in adolescent in Italy]. J Prev Med Hyg 2019; 60:E1-E94. [PMID: 32047867 PMCID: PMC7007189 DOI: 10.15167/2421-4248/jpmh2019.60.3s2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- S Boccalini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - A Bechini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - G Sartor
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - D Paolini
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - M Innocenti
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - P Bonanni
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze
| | - D Panatto
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - P L Lai
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - F Zangrillo
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - F Marchini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - E Lecini
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - M Iovine
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - D Amicizia
- Dipartimento di Scienze della Salute, Università degli Studi di Genova
| | - P Landa
- Dipartimento di Economia, Università degli Studi di Genova
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Gómez BO, Feito CR, Vázquez DGG, Vega MG, García Viejo MÁ. Primary Meningococcal Septic Arthritis Case Report and Literature Review of an Unusual Manifestation of Meningococcal Disease. Bull Hosp Jt Dis (2013) 2019; 77:140-145. [PMID: 31128585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Primary meningococcal septic arthritis (PMSA) is an unusual manifestation of meningococcal disease. It is defined as the presence of acute septic arthritis without association with meningitis or the classic meningococcemia and isolation of Neisseria meningitidis in synovial fluid and blood culture. Diagnosis and early treatment, combining antibiotic and joint drainage, are fundamental. CASE PRESENTATION We present the case of a healthy 17-year-old male who presented with history of an acute onset, painful knee accompanied by fever. N. meningitidis was cultured from the synovial fluid. He was treated with arthroscopic lavage and intravenous ceftriaxone for 2 weeks. He was discharged 7 days after admission receiving outpatient intravenous ceftriaxione for 6 days and was ultimately transitioned to oral ciprofloxacin for 2 weeks thereafter. At the final follow-up visit, he had returned to sports activity with a normal knee joint. LITERATURE REVIEW We have done an exhaustive literature review in PubMed. Forty-four articles were included, with a total of 46 patients, to which we added ours. We collected the available demographic data, analytical values, culture tests, treatment, and evolution. PURPOSES AND CLINICAL RELEVANCE This case illustrates an unusual presentation of N. meningitidis infection. Diagnostic suspicion is essential. Joint washing and antibiotics are the mainstays of treatment. Early and proper treatment prevents complications and mortality. Our main objective was to evaluate the diagnostics tools and treatment in PMSA. As a secondary objective, we evaluated the cases with negative cultures in order to evaluate the criteria for the diagnostic suspicion of PMSA.
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Nygaard U, Vissing NH, Steensen M, Andersen CØ, Valentiner-Branth P, Lundstrøm KE, Poulsen A. [Acute meningococcal disease in children and adolescents]. Ugeskr Laeger 2017; 179:V06170443. [PMID: 28874255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Meningococcal disease is a rapidly progressing infection, which continues to cause deaths among children and adolescents. In this review, clinical signs and initial treatment of acute childhood meningococcal disease is described. Operational flow charts have been developed for assessment of non-blanching rash and initial treatment of meningococcal disease.
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Arnáiz-García ME, Arnáiz-García AM, Gutierrez-Diez F, Nistal JF, González-Santos JM, Pulitani I, Amado-Diago C, Arnáiz J. Mutilating Purpura Fulminans in an Adult with Meningococcal Sepsis. P R Health Sci J 2017; 36:179-182. [PMID: 28915308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a dramatic case of meningococcal sepsis manifesting as purpura fulminans in an elderly diabetic woman. Hemodynamic instability and severe bilateral cutaneous lesions involving her hands and feet developed rapidly. Specific antibiotic therapy and the administration of inotropic and vasopressor drugs were initiated. The severity and extension of the cutaneous lesions (attributed to purpura fulminans) worsened because of the need for vasoconstrictors for the treatment of septic shock. Bilateral transmetatarsal and metacarpal amputations were required to stabilize the patient.
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Affiliation(s)
| | - Ana María Arnáiz-García
- Department of Infectious Diseases, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Francisco Gutierrez-Diez
- Department of Cardiovascular Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Juan Francisco Nistal
- Department of Cardiovascular Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Ivana Pulitani
- Department of Cardiovascular Surgery, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Carlos Amado-Diago
- Department of Pneumology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Javier Arnáiz
- Department of Radiology, Aspetar-Orthopaedic and Sports Medicine Hospital, Al Buwairda St. Doha, Qatar
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Kovács Á, Kulcsár A, Kalabay L, Torzsa P. [Prevention of invasive meningococcal infection, recognition and first treatment of the disease in primary care]. Ideggyogy Sz 2017; 70:151-158. [PMID: 29870630 DOI: 10.18071/isz.70.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Neisseria meningitidis, the meningococcus, is a Gram-negative diplococcal bacterium that is only found naturally in humans. The meningococcus is part of the normal microbiota of the human nasopharynx and is commonly carried in healthy individuals. In some cases systemic invasion occurs, which can lead to meningitis and/or septicemia. Invasive disease caused by Neisseria meningitidis is potentially devastating, with a high case fatality rate and high rates of significant sequelae among survivors after septicaemia or meningitis. Between 2006-2015 every year between 34 and 70 were the numbers of the registered invasive disease because of Neisseria meningitis, the morbidity rate was 0.2-0.7⁰⁄₀₀₀₀. Half of the diseases (50.7%) were caused by B serotype N. meningitidis, 23.2% were C serotype. In this article the authors summarise what you must do and must not do as primary care physician when suddenly meeting a young patients suspected of having meningococcus infection.
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Affiliation(s)
- Ákos Kovács
- Semmelweis Egyetem, Családorvosi Tanszék, Budapest
| | - Andrea Kulcsár
- Egyesített Szt. István és Szt. László Kórház, Központi Gyermek Szakrendelô, Védôoltási Szakrendelô, Budapest
| | | | - Péter Torzsa
- Semmelweis Egyetem, Családorvosi Tanszék, Budapest
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Pearson IC, Baker R, Sullivan AK, Nelson MR, Gazzard BG. Meningococcal infection in patients with the human immunodeficiency virus and acquired immunodeficency syndrome. Int J STD AIDS 2016; 12:410-1. [PMID: 11368827 DOI: 10.1258/0956462011923237] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Meningococcal infection is believed to be rare in HIV-positive individuals. We present 2 cases from our reference caseload within the last 10 years.
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Affiliation(s)
- I C Pearson
- Department of HIV Medicine, Chelsea & Westminster Hospital, Fulham Road, London SW10 9NH, UK
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10
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Zhdanov KV, Ivanov KS, Zakharenko SM, Iaremenko MV, Peredel'skiĭ EV. [Meningococcal disease: early clinical diagnosis and emergency care]. Voen Med Zh 2015; 336:29-35. [PMID: 25916034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Late diagnosis of meningococcal disease leads to high mortality. Early diagnosis of its generalized forms plays a crucial role in the pre-hospital phase and mainly based on the clinical picture of the disease. In most cases, pre-hospital typical mistake is late diagnosis of meningococcal disease: We propose an algorithm of early diagnosis of generalized forms of the disease in order to reduce the number of diagnostic errors. Proper and timely diagnosis will enable the physician pre-hospital fully implement measures to provide emergency and urgent care in generalized meningococcal infection, leading to. a more.favourable course and a significant improvement in the outcomes of the disease in the course of further hospital treatment.
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Dowson A. Prevention and treatment of meningococcal disease. Nurs Times 2014; 110:23-25. [PMID: 24923009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Meningococcal disease is a leading cause of death in children and young people. Part 1 of this two-part series discussed its epidemiology, pathophysiology, signs and symptoms (Dowson, 2014). Part 2 reviews the diagnosis, management and prevention of this disease.
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Cole B. Identifying and treating a life-threatening disease. Emerg Nurse 2014; 21:18-21. [PMID: 24494767 DOI: 10.7748/en2014.02.21.9.18.e1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Meningococcal septicaemia is a life-threatening condition that all nurses working in emergency and urgent care settings are likely to come across during their careers. This article presents, and reflects on, a case study involving a woman with the disease whose signs and symptoms were atypical, and who was not therefore diagnosed with the condition immediately. The author aims to raise awareness among emergency nurses and nurse practitioners of the atypical signs and symptoms of the infection, and its consequences. The article also discusses how referring to patient scenarios can improve practice.
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Affiliation(s)
- Beverley Cole
- Trowbridge Community Hospital, Wiltshire, Emergency department
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Sokołowski R, Targowski T. [Invasive meningococcal disease]. Pol Merkur Lekarski 2012; 33:255-260. [PMID: 23394035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Invasive meningococcal disease a serious problem for public health. Two severe clinical manifestations--spinal meningitis and septicemia--are diseases extending very rapidly with serious prognosis. Pathogenic bacterium--Neisseria meningitidis--is the only natural reservoir in human beings. In Poland during the last 10 years, the incidence of meningococcal disease is steadily increasing with localized outbreaks of epidemic. Treatment of infection is effective when the early diagnosis has been done. In the recent years, significant progress has been made in immunoprophylaxis of infections, and the introduction of vaccines against Neisseria meningitidis into the national calendar gave the significant reduction of invasive infection.
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Affiliation(s)
- Rafał Sokołowski
- Military Institute of Medicine in Warsaw, Central Clinical Hospital of the Ministry of National Defense, Department of Internal Medicine, Pneumonology and Allergology.
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Willcox A. Meningococcal B disease: assessment and management. Nurs Stand 2012; 26:50-58. [PMID: 22482189 DOI: 10.7748/ns2012.02.26.26.50.c8971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Serogroup B meningococcal disease is the last main cause of bacterial meningitis and septicaemia in the UK. There is currently no vaccine against this serogroup. This article outlines the nature of meningococcal disease and highlights recent guidance from the National Institute for Health and Clinical Excellence on recognising and managing the disease in primary and secondary care. An update on progress towards a preventive vaccine is also discussed.
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Abstract
This article is based on two case studies in which children with suspected meningococcal disease were brought to the author's emergency department. It examines the signs and symptoms of the disease, and discusses its management. Emergency practitioners should understand and recognise the signs and symptoms of serious meningococcal disease and refer children to paediatric services immediately.
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Affiliation(s)
- Siba Prosad Paul
- St Richard's Hospital, part of Western Sussex Hospitals NHS Trust
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Haines C. Optimizing clinical care for infants, children and young people with bacterial meningitis and meningococcal septicaemia: 'NICE' guidance plus an insight into its development. Nurs Crit Care 2011; 15:276-80. [PMID: 21040257 DOI: 10.1111/j.1478-5153.2010.00432.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rajapaksa S, Starr M. Meningococcal sepsis. Aust Fam Physician 2010; 39:276-278. [PMID: 20485712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Meningococcal disease remains a significant illness with an overall mortality of around 8%. The majority of deaths occur in the first 24 hours, before the commencement of specialist care. Missing a diagnosis of meningococcal disease is a fear among health care practitioners. OBJECTIVE This article presents a guide to identifying the salient features of meningococcal sepsis and initial management strategies in the primary care setting. DISCUSSION Initial presentation is often nonspecific and therefore it is important to have a high index of suspicion in children presenting with fever, lethargy, myalgia, vomiting and headache. These children should be monitored and reviewed carefully. If a nonblanching rash develops, immediate treatment, liaison with a paediatric intensive care unit and urgent hospital transfer is required. Initial management involves assessment and regular review of airway, breathing and circulation. Antibiotics (preferably intravenous cephalosporin) should be administered before hospital transfer.
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Affiliation(s)
- Shabna Rajapaksa
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Takac I, Kvolik S, Divkovic D, Kalajdzic-Candrlic J, Puseljic S, Izakovic S. Conservative surgical management of necrotic tissues following meningococcal sepsis: case report of a child treated with hyperbaric oxygen. Undersea Hyperb Med 2010; 37:95-99. [PMID: 20462141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This article presents the case of a 5-month-old infant, who survived a fulminant meningococcal sepsis with purpura fulminans, septic shock and severe DIC with gastrointestinal bleeding. Amputation and reconstructive surgery were considered to treat the multiple skin and limb necroses at high risk of superinfection, but the surgical intervention was delayed due to the extremely doubtful outcome. On Day 10 after the onset of the disease, a hemodynamic improvement was achieved. The baby overcame early critical period, but was still in poor general condition. The hyperbaric oxygenation (HBO2) as adjuvant therapy was started in the monoplace chamber using the following protocol: from first through fifth day 45 minutes twice a day on 1.5 atmosphere absolute (ATA); after a two-day break, once a day on 1.8 ATA for 60 minutes. During 52 HBO2 treatments multiple areas of necrotic skin and subcutaneous tissue, together with fingertips and toes, detached spontaneously. All wounds healed without reinfections. An increased oxygen concentration during HBO2 therapy promoted spontaneous wound healing. Bacterial superinfection was not observed in numerous low-perfused lesions. Since repeated anesthesia and surgical interventions were not needed, a final invalidity was minimized. To the best of our knowledge, this is the first report on the successful conservative surgical treatment of this mutilating disease without aggressive reconstructive surgery in an infant with the help of HBO2.
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Affiliation(s)
- Ines Takac
- Department of Anesthesiology & ICU, Clinical Hospital Osijek, J Huttlera 4, Osijek, Croatia
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Schweon SJ. Meningococcal pneumonia. RN 2009; 72:22-25. [PMID: 19743586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Donovan C, Blewitt J. An overview of meningitis and meningococcal septicaemia. Nurs Stand 2009; 23:42-52. [PMID: 19678517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article provides an overview of meningitis and meningococcal septicaemia, which can have devastating effects. Nurses working in acute and primary care need to be able to recognise the causes and symptoms of these conditions, and have up-to-date knowledge of treatment, prevention and potential after-effects.
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Abstract
A case of primary purulent meningococcal pericarditis, presenting with hemodynamic derangement due to tamponade, is reported. Treatment was successfully fulfilled with antibiotics and surgical drainage, using continuous percutaneous subxiphoidal catheter drainage with the Seldinger technique. Less than ten cases of this potentially lethal entity have been reported in the literature.
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Gutvirth J. [Peracute meningococcal sepsis in a 14-year-old female patient]. Klin Mikrobiol Infekc Lek 2009; 15:33-34. [PMID: 19642259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Hague R. Meningococcal disease warrants prompt referral. Practitioner 2008; 252:17-20. [PMID: 18773717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Theilen U, Wilson L, Wilson G, Beattie JO, Qureshi S, Simpson D. Management of invasive meningococcal disease in children and young people: summary of SIGN guidelines. BMJ 2008; 336:1367-70. [PMID: 18556318 PMCID: PMC2427067 DOI: 10.1136/bmj.a129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- U Theilen
- Department of Anaesthesia and Paediatric Critical Care, Royal Hospital for Sick Children, Edinburgh EH9 1LF
| | - L Wilson
- Department of Public Health and Health Policy, University of Glasgow, Glasgow
| | - G Wilson
- High Dependency Unit, Royal Aberdeen Children’s Hospital, Aberdeen
| | - J O Beattie
- Department of Emergency Medicine, Royal Hospital for Sick Children, Glasgow
| | - S Qureshi
- Scottish Intercollegiate Guideline Network, Edinburgh
| | - D Simpson
- Department of Anaesthesia and Paediatric Critical Care, Royal Hospital for Sick Children, Edinburgh EH9 1LF
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Affiliation(s)
- David Isaacs
- Department of Infectious Diseases and Microbiology, Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
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Ross Russell R, Morley SL, Latifi S, Faizal MAM, Day T. Tracheal intubation in meningococcal disease and septic shock. Arch Dis Child 2008; 93:181. [PMID: 18208998 DOI: 10.1136/adc.2007.132159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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O'Dell E, Tibby SM, Durward A, Murdoch IA. Hyperchloremia is the dominant cause of metabolic acidosis in the postresuscitation phase of pediatric meningococcal sepsis. Crit Care Med 2007; 35:2390-4. [PMID: 17717489 DOI: 10.1097/01.ccm.0000284588.17760.99] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Metabolic acidosis is common in septic shock, yet few data exist on its etiological temporal profile during resuscitation; this is partly due to limitations in bedside monitoring tools (base excess, anion gap). Accurate identification of the type of acidosis is vital, as many therapies used in resuscitation can themselves produce metabolic acidosis. DESIGN Retrospective, cohort study. SETTING Multidisciplinary pediatric intensive care unit with 20 beds. PATIENTS A total of 81 children with meningococcal septic shock. INTERVENTIONS None. MEASUREMENTS AND RESULTS Acid-base data were collected retrospectively on 81 children with meningococcal septic shock (mortality, 7.4%) for the 48 hrs after presentation to the hospital. Base excess was partitioned using abridged Stewart equations, thereby quantifying the three predominant influences on acid-base balance: sodium chloride, albumin, and unmeasured anions (including lactate). Metabolic acidosis was common at presentation (mean base excess, -9.7 mmol/L) and persisted for 48 hrs. However, the pathophysiology changed dramatically from one of unmeasured anions at admission (mean unmeasured anion base excess, -9.2 mmol/L) to predominant hyperchloremia by 8-12 hrs (mean sodium-chloride base excess, -10.0 mmol/L). Development of hyperchloremic acidosis was associated with the amount of chloride received during intravenous fluid resuscitation (r = .44), with the base excess changing, on average, by -0.4 mmol/L for each millimole per kilogram of chloride administered. Hyperchloremic acidosis resolved faster in patients who 1) manifested larger (more negative) sodium chloride-partitioned base excess, 2) maintained a greater urine output, and 3) received furosemide; and slower in those with high blood concentrations of unmeasured anions (all, p < .05). CONCLUSIONS Hyperchloremic acidosis is common and substantial after resuscitation for meningococcal septic shock. Recognition of this entity may prevent unnecessary and potentially harmful prolonged resuscitation.
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Affiliation(s)
- Ellen O'Dell
- Pediatric Intensive Care Unit, Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Gray MP, Gour A, Davison C, Round J, Murdoch L. Indication for tracheal intubation in meningococcal disease and septic shock. Arch Dis Child 2007; 92:827. [PMID: 17715452 PMCID: PMC2084022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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29
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Chiu YH, How CK, Chern CH, Wang LM, Huang CI. Cardiac rescue with intra-aortic balloon counterpulsation in refractory shock due to acute meningococcemia. Am J Emerg Med 2007; 25:253-4. [PMID: 17276846 DOI: 10.1016/j.ajem.2006.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 11/28/2006] [Indexed: 10/23/2022] Open
Affiliation(s)
- Yu-Hui Chiu
- Emergency Department, Taipei Veterans General Hospital, Taipei 112, Taiwan; National Yang-Ming University School of Medicine, Taiwan
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Abstract
Application of the new edition of the meningococcal treatment algorithm may help in the early management of critically ill patients
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31
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Arias IM, Henning TD, Alba LM, Rubio S. A meningococcal endocarditis in a patient with Sweet's syndrome. Int J Cardiol 2007; 117:e51-2. [PMID: 17292496 DOI: 10.1016/j.ijcard.2006.11.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2006] [Accepted: 11/11/2006] [Indexed: 11/23/2022]
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Elias J, Reinhardt M, Hautmann W, Harms I, Oppermann H, Schröter M, Hellenbrand W, Oster P, Kurzai O, Taha MK, Nossal R, Frosch M, Vogel M. 3. Würzburger Workshop zur Epidemiologie, Prävention und Therapie der invasiven Meningokokkenerkrankung 2006. Gesundheitswesen 2007; 69:256-62. [PMID: 17533569 DOI: 10.1055/s-2007-973087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
On October 5th, 2006, the German Reference Centre for Meningococci (NRZM) held the 3rd Workshop on Epidemiology, Prevention and Treatment of Invasive Meningococcal Disease, in collaboration with the German Society for Hygiene and Microbiology (DGHM). Given the recent recommendation of the German Standing Committee on Vaccination (STIKO) for conjugate meningococcal C vaccination of all children in the second year of life, observations from meningococcal C conjugate vaccination campaigns in other European countries were presented and compared to the German situation. Moreover, the newly implemented cluster detection routines employed at the NRZM and their integration into the interactive geographical information system EpiScanGIS were shown. Based on recent experiences from regional outbreaks in Oberallgäu, Sangerhausen, and Greater Aachen, examples for public health intervention were given at the conference. In addition, current developments in the area of meningococcal research, as well as trends in antimicrobial susceptibility were covered. Finally, the latest evidence concerning the clinical management and chemoprophylaxis of this invasive bacterial disease was discussed.
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Affiliation(s)
- J Elias
- Nationales Referenzzentrum für Meningokokken, Institut für Hygiene und Mikrobiologie, Universität Würzburg, Germany.
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Gjini AB, Stuart JM, Cartwright K, Cohen J, Jacobs M, Nichols T, Ninis N, Prempeh H, Whitehouse A, Heyderman RS. Quality of in-hospital care for adults with acute bacterial meningitis: a national retrospective survey. QJM 2006; 99:761-9. [PMID: 17071621 DOI: 10.1093/qjmed/hcl111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Most adults with bacterial meningitis and meningococcal septicaemia present to junior doctors who have limited experience of these conditions. In contrast to paediatric practice, data from industrialized countries with regard to current hospital management practice are lacking. AIM To examine whether current practice meets recommended standards in hospital management of community-acquired bacterial meningitis and meningococcal septicaemia among adults. DESIGN National audit of medical records. METHODS We conducted a survey of all patients with acute bacterial meningitis and meningococcal septicaemia admitted to 18 randomly selected acute hospitals in England and Wales between 1 January 2000 and 31 December 2001. All stages of care, including pre-hospital management, initial hospital assessment, record keeping, and ongoing hospital and public health management, were assessed. RESULTS We identified 212 cases of bacterial meningitis and meningococcal septicaemia; 190 cases remained in the final analysis. Clinical record keeping did not meet acceptable standards in 33% of cases. Parenteral antibiotics were given within 1 h of hospital arrival in 56% of cases, increasing to 79% among those with an initial differential diagnosis that included bacterial meningitis or meningococcal septicaemia. A full severity of illness assessment was made in 27%. The quality of clinical practice varied widely between hospitals. This was most pronounced in the timeliness of consultant review (p < 0.0005). DISCUSSION The quality of adult clinical practice for bacterial meningitis and meningococcal septicaemia needs improvement. This study provides a tool for developing targeted interventions to improve quality of care and outcome among adults with life-threatening infections, both in the UK and in other countries.
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Affiliation(s)
- A B Gjini
- Social Medicine Department, University of Bristol, Canynge Hall, Whiteladies Road, Bristol, UK.
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Affiliation(s)
- C Anthony Hart
- Department of Medical Microbiology, University of Liverpool, Liverpool L69 3GA.
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35
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Lemberger C. [Meningococcal infection. Clinical, therapeutic and nursing aspects]. Kinderkrankenschwester 2006; 25:318-21. [PMID: 16937826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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36
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Affiliation(s)
- Julia L Busta
- Emergency Department, Advocate-Illinois Masonic Medical Center, Chicago, USA
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37
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Valbonesi M, Pallavicini FB, Cannella G, Zinno E, Patrone F, Carlier P, Dejana A, Morelli F. MOF induced by meningococcal sepsis: successful outcome after intensive multidisciplinary approaches. Transfus Apher Sci 2005; 33:75-7. [PMID: 16009597 DOI: 10.1016/j.transci.2005.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Accepted: 03/11/2005] [Indexed: 11/19/2022]
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38
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Haasnoot M, van Leeuwen E, Plötz FB. [Decision-making regarding life-sustaining medical treatment in a pediatric intensive-care unit]. Ned Tijdschr Geneeskd 2005; 149:2029-31. [PMID: 16184941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The complexity of the decision-making process regarding life-sustaining medical treatment was illustrated by the single case of a 12-year-old boy with severe meningococcal septicaemia. When his clinical condition deteriorated, necessitating haemodialysis and multiple amputations of the extremities, questions about the futility of treatment and the future quality of life puzzled the attending physician. In consultation with the treatment team and the parents, it was decided to continue medical treatment in this patient since there was too little prognostic certainty concerning bodily functions and morbidity and the expected future quality of life. After 60 days, the patient was discharged. Half-a-year later he was following an intensive rehabilitation programme and the possibility of renal transplantation was contemplated. Because of the consequences for the child and his family, a decision to continue life-sustaining medical treatment should be justified as thoroughly as one to withdraw or withhold treatment.
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Affiliation(s)
- M Haasnoot
- VU Medisch Centrum, Postbus 7057, 1007 MB Amsterdam
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39
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40
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Ninis N, Phillips C, Bailey L, Pollock JI, Nadel S, Britto J, Maconochie I, Winrow A, Coen PG, Booy R, Levin M. The role of healthcare delivery in the outcome of meningococcal disease in children: case-control study of fatal and non-fatal cases. BMJ 2005; 330:1475. [PMID: 15976421 PMCID: PMC558454 DOI: 10.1136/bmj.330.7506.1475] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether suboptimal management in hospital could contribute to poor outcome in children admitted with meningococcal disease. DESIGN Case-control study of childhood deaths from meningococcal disease, comparing hospital care in fatal and non-fatal cases. SETTING National statistics and hospital records. SUBJECTS All children under 17 years who died from meningococcal disease (cases) matched by age with three survivors (controls) from the same region of the country. MAIN OUTCOME MEASURES Predefined criteria defined optimal management. A panel of paediatricians blinded to the outcome assessed case records using a standardised form and scored patients for suboptimal management. RESULTS We identified 143 cases and 355 controls. Departures from optimal (per protocol) management occurred more frequently in the fatal cases than in the survivors. Multivariate analysis identified three factors independently associated with an increased risk of death: failure to be looked after by a paediatrician, failure of sufficient supervision of junior staff, and failure of staff to administer adequate inotropes. Failure to recognise complications of the disease was a significant risk factor for death, although not independently of absence of paediatric care (P = 0.002). The odds ratio for death was 8.7 (95% confidence interval 2.3 to 33) with two failures, increasing with multiple failures. CONCLUSIONS Suboptimal healthcare delivery significantly reduces the likelihood of survival in children with meningococcal disease. Improved training of medical and nursing staff, adherence to published protocols, and increased supervision by consultants may improve the outcome for these children and also those with other life threatening illnesses.
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Affiliation(s)
- Nelly Ninis
- Infectious Diseases Unit, Department of Paediatrics, Faculty of Medicine, Imperial College of Science, Technology and Medicine, London W2 1PG.
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41
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Abstract
Due to a high complication and case fatality rate, meningococcal diseases are important health problems both in tropical countries experiencing severe epidemics as well as in countries of moderate climate zones. Worldwide N. meningitidis of sero-groups A, B, and C are predominant and to a lesser extent serogroups W (135) and Y play a role, whereas in Europe more than 90 % of meningococcal diseases are caused by serogroups B and C of N. meningitidis. In Germany and other developed countries the majority of cases occur in very young children and adolescents. Since many years, meningococcal polysaccharide vaccines against diseases due to N.meningitidis serogroup A, C, Y and W (135) are commercially available. Unfortunately, a vaccine against diseases caused by N. meningitidis serogroup B is still under development. The recently developed and licensed conjugated meningococcal vaccines against N. meningitidis serogroup C are also protective against disease in very young children. Eight countries in Western Europe as well as Australia have already established country-wide immunization programs for children and adolescents. Within only 2 to 3 years, well managed programs have achieved far-reaching control of meningococcal C disease in UK and the Netherlands. In Germany, the Advisory Committee on Immunization (STIKO recommends immunization for selected risk groups. The current increase of the percentage of meningococcal C diseases to 28 - 30 % gives reason for further discussion regarding immunization strategies. How-ever, the STIKO expressively declares, that in addition to the recommendation for risk groups, the physician can use all vaccines licensed in Germany without any restriction. It is his/her responsibility to advice the patients regarding immunization possibilities against the life-threatening meningococcal disease, particularly if cases are occurring.
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Affiliation(s)
- S Dittmann
- Arbeitsgemeinschaft Meningokokken des Deutschen Grünen Kreuzes e.V.
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Abubakar I, Williams CJ, McEvoy M. Development and evaluation of a hand held computer based on-call pack for health protection out of hours duty: a pilot study. BMC Public Health 2005; 5:35. [PMID: 15823207 PMCID: PMC1084354 DOI: 10.1186/1471-2458-5-35] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2004] [Accepted: 04/11/2005] [Indexed: 12/05/2022] Open
Abstract
Background The on call service for health protection in most parts of the UK is provided by general public health consultants, registrars and nurses as the first tier of response backed up by medical consultants in health protection. The first tier responder usually carries a large bag of papers containing both local and national guidance on the management of common cases/incidents. An electronic on call pack may provide a suitable practical alternative to large paper based systems and help professionals deliver out of hours health protection advice and response to incidents. Methods We developed and piloted an electronic on call pack in Hertfordshire for use at the health protection unit level containing key local and national guidelines, contact information and useful references. The on-call pack was initially piloted using a laptop and more recently using a personal digital assistant (PDA). The use of the on-call pack was evaluated. Results Key advantages of the electronic system include reduced size, faster access to information that is clearly indexed and the relative ease of updating information. As part of the pilot, the electronic on call pack was presented to a local and regional training meeting with good response from participants using qualitative and quantitative methods. Conclusion It is anticipated that with suitable evaluation this system can be adapted and utilised by other health protection practitioners. This system provides a fast, reliable and easily maintained source of information for the public health on-call team.
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Affiliation(s)
- Ibrahim Abubakar
- Health Protection Agency (East of England) Regional Epidemiology Unit, Institute of Public Health, Cambridge, CB2 2SR, UK
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Christopher J Williams
- Health Protection Agency, East and North Hertfordshire Health Protection Unit, Charter House, Welwyn Garden City, UK
| | - Marian McEvoy
- Health Protection Agency, East and North Hertfordshire Health Protection Unit, Charter House, Welwyn Garden City, UK
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Abstract
The aim of this study was to describe the lived experience of parents whose child had suffered from and survived severe meningococcal disease. A Heideggerian phenomenological approach was used within the study and data were collected from long focused interviews. In total, eight parents took part in the study; one was a woman recruited as a pilot interview and the other seven were recruited for the main study. The data were analysed using Colaizzi's (1978) method. Eleven themes emerged: (1) complications/side effects; (2) emotional turmoil; (3) child's physical appearance; (4) family disruption; (5) fear of death; (6) loss of parenting role; (7) need for support and understanding; (8) need and value of communication, information and publicity; (9) parental intuition; (10) technological interventions and (11) the impact of care delivery. A review of the literature arising out of the data was undertaken, and a final synthesis statement as perceived by the parents was achieved. Living through this experience is perceived as a major emotional stressor, and although health professionals have some insight into the experience, they are largely naive to the enormity of the situation.
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Affiliation(s)
- Caroline Haines
- Paediatric Intensive Care/High Dependency, Bristol Royal Hospital for Children, United Bristol Healthcare Trust, Upper Maudlin Street, Bristol.
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44
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Schmidt H, Flieger RR, Hennen R, Tymiec P, Winkler M, Hoyer D, Buerke M, Müller-Werdan U, Werdan K. Reversible autonome Dysfunktion bei einer jungen Patientin mit septischem Multiorgan-Dysfunktionssyndrom. Dtsch Med Wochenschr 2005; 130:648-51. [PMID: 15776347 DOI: 10.1055/s-2005-865075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
HISTORY A 24-year-old woman was admitted for treatment of a meningococcal infection accompanied by fulminant autonomic dysfunction. INVESTIGATIONS Laboratory tests indicated acute renal failure and disseminated intravascular coagulopathy (creatinine 183 mmol, D-dimer 1.52 mg/l). The initial central venous oxygen saturation was 60-65%. The diagnosis of severe septic shock was supported by a high procalcitonin level of 66.7 ng/ml, CRP of 79.8 mg/l, and a WBC count of 12.2 Gpt/l. TREATMENT AND COURSE Treatment of sepsis with antibiotics (ciprofloxacin, penicillin G, ceftriaxon and erythromycin in standard dosages), activated protein-C, hydrocortisone and GMA-embedded immunoglobulin led to complete cure and restoration of normal autonomic function. CONCLUSIONS This case shows that even in multiple organ dysfunction syndrome autonomic dysfunction can occur which is improved by adequate treatment.
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Affiliation(s)
- H Schmidt
- Universitätsklinik und Poliklinik für Innere Medizin III.
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45
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Affiliation(s)
- Marc Fischer
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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46
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Abstract
Purpura fulminans associated with meningococcemia is a devastating disease in children. The tissue loss can be extensive and difficult to determine at the outset. The authors suggest a strategy to manage these wounds with the goal of preserving as much tissue and function as possible. At the present time, conservative therapy to the wounds appears to be the best course in the initial, critical phase, as long as no active local purulence is found. Debridement or amputation is performed when the nonviable tissue margins are delineated. Temporary coverage with allograft may be required; definitive coverage is accomplished when the local tissue perfusion has recovered. Future revisions are often necessary to improve these children's quality of life.
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Affiliation(s)
- Tue A Dinh
- Division of Plastic Surgery, Baylor College of Medicine, Scurlock Tower, 6560 Fannin, Suite 800, Houston, TX 77030, USA.
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47
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Saxén H. [Meningococcal sepsis in a 15-year old girl's knee]. Duodecim 2005; 121:333. [PMID: 15787296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Harri Saxén
- HUS Lasten ja nuorten sairaala, PL 281, 00029 HUS.
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Luyt DK, Pridgeon J, Brown J, Peek G, Firmin R, Pandya HC. Extracorporeal life support for children with meningococcal septicaemia. Acta Paediatr 2004; 93:1608-11. [PMID: 15841769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To describe the short-term outcome of children with meningococcal sepsis treated with extracorporeal membrane oxygenation (ECMO) in a single centre. DESIGN Retrospective analysis of case notes. SETTING The Heartlink ECMO Centre, Glenfield Hospital, Leicester. PATIENTS Eleven children (8 boys) out of a total caseload of 800 patients were treated for meningococcal sepsis with ECMO. INTERVENTIONS Extracorporeal membrane oxygenation. RESULTS All children with meningococcal sepsis treated with ECMO had a Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS) > or = 12 (positive predictive risk of death of approximately 90%). Five children had adult respiratory distress syndrome (ARDS) and six had refractory shock with multi-organ dysfunction syndrome (MODS) at presentation for ECMO. All five children in the ARDS group survived, four of five receiving veno-venous (VV-) ECMO therapy. In contrast, only one of six children with refractory shock with MODS survived, all of whom required veno-arterial (VA-) ECMO therapy. CONCLUSIONS Most children with meningococcal sepsis and severe ARDS can be successfully treated with VV-ECMO. In contrast, children with refractory shock and MODS die despite treatment with VA-ECMO. This report does not resolve whether ECMO therapy offers any advantage over conventional therapy in treating severe meningococcal sepsis.
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Affiliation(s)
- D K Luyt
- Heartlink ECMO Centre, Glenfield Hospital, Leicester, United Kingdom
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Serruto D, Adu-Bobie J, Capecchi B, Rappuoli R, Pizza M, Masignani V. Biotechnology and vaccines: application of functional genomics to Neisseria meningitidis and other bacterial pathogens. J Biotechnol 2004; 113:15-32. [PMID: 15380644 DOI: 10.1016/j.jbiotec.2004.03.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2003] [Revised: 03/09/2004] [Accepted: 03/19/2004] [Indexed: 10/26/2022]
Abstract
Since its introduction, vaccinology has been very effective in preventing infectious diseases. However, in several cases, the conventional approach to identify protective antigens, based on biochemical, immunological and microbiological methods, has failed to deliver successful vaccine candidates against major bacterial pathogens. The recent development of powerful biotechnological tools applied to genome-based approaches has revolutionized vaccine development, biological research and clinical diagnostics. The availability of a genome provides an inclusive virtual catalogue of all the potential antigens from which it is possible to select the molecules that are likely to be more effective. Here, we describe the use of "reverse vaccinology", which has been successful in the identification of potential vaccines candidates against Neisseria meningitidis serogroup B and review the use of functional genomics approaches as DNA microarrays, proteomics and comparative genome analysis for the identification of virulence factors and novel vaccine candidates. In addition, we describe the potential of these powerful technologies in understanding the pathogenesis of various bacteria.
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Affiliation(s)
- Davide Serruto
- IRIS, Chiron Vaccines, Via Fiorentina 1, 53100 Siena, Italy
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50
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Abstract
Upper respiratory tract infections (ie, "the common cold") have several hundred causes, the most common of which include rhino-virus, coronavirus, and respiratory syncytial virus. The clinical presentation varies with symptoms. Every emergency department, no matter what the demographics, cares for patients with this constellation of symptoms. Emergency physicians examine, diagnose, and treat these disorders frequently. With increasing burdens being placed on emergency physicians, it is possible to assume a diagnosis of upper respiratory tract infection without generating a complete differential diagnosis. The challenge is to identify and recognize the distinctions between an innocuous upper respiratory tract infection and a life-threatening disease "mimic" or entities. This article discusses some of these life-threatening mimics.
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Affiliation(s)
- Robert Lowenstein
- Department of Emergency Medicine, Boston Medical Center, Dowling 1 South, 1 Boston Medical Center Place, Boston, MA 02118, USA.
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