11 January 2006

New warning signs for child meningitis

Scotsman

LOUISE GRAY

Key points
• Research has highlighted three new earlier symptoms of meningitis
• New signs include cold hands and feet, mottled skin colour and leg pain
• Meningitis Trust estimates 3,000 people a year in the UK become infected

Key quote
"Early diagnosis and treatment is crucial to increase the likelihood of patient survival," - Harry Burns, the chief medical officer for Scotland

THOUSANDS of children's lives will be saved after meningitis researchers identified new early-warning signs for parents.

Until now, parents have been warned to look out for their child having a headache, stiff neck, sensitivity to light and a pinprick rash as signs of meningitis. But these symptoms can occur as little as two hours from the child becoming critically ill or even dying, leaving little time for treatment.

Now research has highlighted three new earlier symptoms of the infection - leg pain, cold hands and feet, and an abnormally pale, mottled skin colour - which together, or separately with other signs such as fever, can be indicators of the condition.

Doctors said the findings could speed up diagnosis and treatment of the disease, which the Meningitis Trust estimates infects 3,000 people a year in the UK, killing 300 - mostly children. Worldwide, the figure runs into thousands.

Dr Matthew Thomson, from Oxford University, who led the research, agreed that spotting the signs of the disease earlier could save thousands of lives.

"This disease develops so quickly in children - from the child becoming ill to being dead within 24 hours," he said. "The sooner a child can be spotted and admitted to hospital, the more likely they are to survive and do well."

Dr Thompson led a team investigating children who contracted the most dangerous, bacterial form of meningitis.

Most had only non-specific symptoms in the first four to six hours, but were close to death 24 hours after infection. Classic symptoms developed late, after an average of 13 to 22 hours. However, 72 per cent of the children developed identifiable early sepsis (infection) symptoms in just eight hours on average.

Almost three out of four parents noticed the onset of symptoms such as cold hands and feet, leg pain, and abnormal pallor up to 19 hours before their children were admitted to hospital.

In an online edition of the medical journal, The Lancet, published today, the researchers wrote: "

Although we must avoid undermining the importance of classic symptoms, we could substantially speed up diagnosis if the emphasis was shifted to early recognition of sepsis."

The researchers analysed patient questionnaires and scoured medical records.

Of the 448 children surveyed, all aged 16 or younger, 103 died and 345 survived. Only half the children were sent to hospital the first time they saw a doctor. In many cases, children were admitted to hospital only after an initial misdiagnosis, the research found. Generally, doctors look for the classic symptoms of rash, headaches, stiff neck, light sensitivity and impaired consciousness.

"We believe that primary-care clinicians are over-reliant on using these three symptoms to diagnose meningococcal disease in children, and that parents may be influenced by doctors or public health campaigns to seek medical advice only on the appearance of features such as a rapidly evolving rash," said Dr Thompson's team. "Moreover, clinicians and parents may be falsely reassured by the absence of these features."

Often children were seen by a local GP who had never encountered a case of meningitis outside hospital.

Dr Thompson warned that the research was in the early stages, but recommended that all parents be informed of the new warning signs.

The new warnings relate to the early signs of meningococcal disease, which can lead to meningitis as well as septicaemia and blood poisoning.

Vaccination can protect children against meningitis C, but other strains, most commonly meningitis B, kill children and adults indiscriminately.

In developed countries, meningitis, with its associated illnesses, are the leading infectious causes of death in children. At least four in 100,000 British children will at some time become ill with meningococcal disease.

Harry Burns, the chief medical officer for Scotland, promised to examine the research. "Early diagnosis and treatment is crucial to increase the likelihood of patient survival," he said. "We will look closely at the findings and consider carefully our advice to parents and doctors."

Olivia Giles, an Edinburgh lawyer who lost her limbs to meningococcal septicaemia in 2002, said the symptoms of blood poisoning, such as the pallor caused by blood rushing to protect vital organs, were well known.

But she said the fact it occurs earlier than classic symptoms should be stressed to all parents.

"You should be on the alert and have the information in the house or your purse so if you feel something is not normal you can look at the information and monitor the symptoms."

Ms Giles suffered from the early symptoms. "My hands and feet felt like blocks of ice and I had a horrible pallor from very early on," she said.

But it was not until 24 hours later, when the classic symptoms of meningococcal septicaemia emerged, that she was rushed to hospital. Doctors were left with no option but to amputate her hands and feet.

"Every second counts," says Ms Giles. "The minute it gets into your blood, it spreads rapidly. The sooner they give you the antibiotics, the less damage it will do."

Miss Giles, 40, who married this summer, added: "Listen to your instincts, be armed and ready to act quickly. You do not wait for a rash. The cold hands and feet is quite a warning."

Beverley Corbett, of the Meningitis Trust, which funded the research, also welcomed the research."Diagnosis of meningococcal disease is extremely difficult in the early stages, especially when classic symptoms are not present," she said. "This is why we emphasise the importance of early symptoms and remaining vigilant."

How the disease strikes

‘Classic’ symptoms:
Red rash
Headache
Stiff neck
Sensitivity to light
Impaired consciousness

‘New’ symptoms:
Leg pain
Cold hands and feet
Abnormally pale or mottled skin colour

>>more info

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