MeningoCoccal Disease: Pearls and Pitfalls

1 December, 2011 by: colinparker

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A tiny, frightening little bug: Neisseria meningitidis.  The challenge for us in healthcare is to squash this little bug before it wreaks its havoc…

Join us for a discussion of ways to protect yourself, and your patients, against the nasty threat of meningococcal disease. It creeps up on you… when you least expect.

Outline: MCD PEMcast

[cp]: Intro, welcome, disclaimer

[cp]: Problematic disease because of non-specific early clinical picture, rapid progression, potentially devastating outcomes, and because relatively uncommon (therefore difficult to get useful data/research)

[CB]: Vaccination covers some serotypes (which?)

[cp]: Challenge / Holy Grail is early diagnosis (& treatment); strategies to try to achieve this are:
– public awareness (more good than harm, despite occasional parent not being reassurable) (organisations, tumbler test)
– healthcare professionals awareness
– formal guidelines & protocols eg early parenteral antibiotics via GP or peripheral setting, prior to transfer to hospital, standardised risk-management protocols eg antibiotic guidelines, ICU consultation, etc
– search for a new test / combination of tests / scoring system etc

[cp]: Clinical features (which stand out from other causes of sepsis or meningitis):
– individually lack specificity but might raise your suspicions
[RR]: – symptoms: non-blanching rash, leg pain, rapid deterioration, others
[cp]: – signs: petechiae / purpura, cold peripheries (toe-core temperature gradient used in Glasgow meningococcal sepsis score), others

[all / cp]: Protective strategies for ED docs:
– be afraid, this disease is deceptive
– a piece of hay that turns into a needle…
– documentation – descriptive, including lay terminology, to paint an accurate clinical picture
– discharge advice for parents in setting of ‘viral illness’ or fever without source
– utilise period of observation when unsure
– keep looking out for new strategies to minimize your own risk

[CB]: Comments from Chris

[all] summary, goodbye

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