Just about to head home at 2 am as usual on a Monday night
been on the floor since 4 pm supervising the department and giving
advice plus saw 16 patients of mixed acuity primarily (my self)
This is a the typical workload of a specialist in our department on a
busy shift. Hard work it is ...(skywalker!)
Anyway .Not sure if PCRs have been discussed on this list before but
would welcome advice.
Caught in the grip of a meningococcal epidemic we have recently adopted
a policy of giving Ceftriaxone to patients (of all ages) with the
criteria of a Systemic Inflammatory Response Syndrome ( fever > 38 ,
tachycardia, high or low WCC, tachypnoea - any two of these four)
irrespective of rashes or meningism. Most discharged if improving after
a few hours.
Exceptions to this blunderbus approach are patients where a clear
specific alternative diagnosis is apparent (most of whom get antibiotics
anyway!)
Every case is investigated with blood cultures and PCR for meningococcal
disease
Numerous such cases over 2 months all and the PCR positive incidence is
sitting at 50 % and our public health colleagues are going nuts
In the past most of these cases would have been labelled viral illness
and never come back
A few have been blood culture positive also and all of these had been
admitted because of more severe clinical illness though not all had a
rash
One of our trainees is collecting data prospectively.
What happens around the world? What use is being made of a PCR test in
the diagnosis of meningococcal disease?
I understand that PCR positive cases are regarded as definite cases in
some countries
If this is true our reporting rate for this disease is about to more
than double
Dr John Chambers
Clinical Leader
Emergency Department
Dunedin New Zealand
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