Good points, Goat!
Oh that we could rely on clinical acumen to diagnose meningococcal
septicaemia
Most times it is easy once the rash is evident but I suspect every
doctor on this list is aware of cases that have initially been labelled
viral or as another diagnosis
Sadly we are getting reports every month of patients dying of
meningococcal septicaemia despite attending GPs or ED departments all
over Australasia. Vaccination must be the ultimate solution.
In New Zealand the fatal cases are looked into by the Health and
Disability Commission and all details circulated widely.
An expert comment regarding a case last year raised the idea of using
SIRS criteria (In Harrison's Textbook of Medicine)to decide if empirical
antibiotics should be administered in patients with flue like illness
Looking back at a few of the fatal cases it appeared that they would
certainly have fulfilled these criteria at initial presentation and
would have received a dose of IV antibiotics
Difficult to know how that would have affected the outcome in the
individual cases.
After two cases were diagnosed late here (one fatal one not)we decided
to go with the SIRS criteria and included blood culture and PCR (Blood ,
and CSF if obtained)in our work up
The early finding of a 50% PCR positive incidence has taken us totally
by surprise.
Not sure what it means ! Hence raising the matter on the list.
JohnC
PS One of our 70 cases was pcr negative but had strep. pneumonia in
blood culture which is not surprising
-----Original Message-----
From: Goat [mailto:[log in to unmask]]
Sent: Wednesday, 31 July 2002 10:37 p.m.
To: [log in to unmask]
Subject: Re: PCR in meningococcal disease
How important is it to "pick up" positive PCRs or rash scrapings in
"well" people? Isn't N.Men sometimes a non-pathogenic finding (e.g.
throats)?
OK if they're PCR+, got "SIRS" and no other apparent cause, its a brave
doc that DOESN'T soak the patient in industrial strength iv
blunderbusillin.
Would you NOT treat them if they were PCR-neg?
What about the other causative bugs (pneumococcus for example)?
Do you PCR for them too?
There is subtle difference between reacting to a MARKER and treating the
DISEASE it points to.
We already have a problem with trainees relying heavily on all sorts of
expensive, slow, fancy new-fangled tests for various dubious
indications. We still miss urgent things that should be picked up by
simpler means (hypoxia, shock, ectopic, MI, hypoglycaemia etc.).
If patients can be saved from devastating disease by new tests, good,
otherwise all they do is muddy the waters further.
Looking forward to the evidence of blinded prospective study into PCR+
as criteria to treat. The ethical approval for that one could be tricky!
In article <[log in to unmask]
p-tr.wmids.nhs.uk>, Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY -
SwarkHosp-TR <[log in to unmask]> writes
>> 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
>
>Off the question a bit, but meningococcal disease is underreported. In
East
>Birmingham Hospital a few years back the infectious disease bods
cultured
>scrapings from all purpuric rashes even in a lot of clinically well
people.
>They got back an awful lot of meningococci. Most places only consider
it if
>the patient is really unwell, but I think there's a lot of mild cases
>around. Lot we don't know (bearing in mind they had a 100% specific
test for
>meningococcal rash- I'm not sure of the specificity of PCR). Major
>implications for contact prophylaxis.
>BTW if nobody else answers Ernest Yeoh's question, PCR = Polymerase
Chain
>Reaction- a sort of serology thing. The good thing in meningococcaemia
is
>that it remains positive after antibiotics. That's all I know about it,
but
>I'm sure there must be a registrar somewhere with a recent MRCP who can
do
>the details.
>
>Matt Dunn
>
>
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Dr G Ray
A&E
Sussex
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