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Subject:

Re: meningitis

From:

Julian Bradley <[log in to unmask]>

Reply-To:

GP-UK <[log in to unmask]>

Date:

Mon, 1 Feb 2010 00:57:10 +0000

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (50 lines)

>saw a young baby with a high fever and diarrhoea in surgery one afternoon. =
>full h/o and o/e=2C including full set vital signs=2C and cns+skin examinat=
>ion=2C fortunately all properly documented. mother concerned but ok. arrang=
>ed to see baby next am if still feverish and 'safetynetted'- again all docu=
>mented. next morning=2C some 20 hours later=2C one of my good partners saw =
>baby as he was going the branch surgery clinic=2C baby was now feverish+irr=
>itable but nil found otherwise so he admitted baby. between seeing baby and=
>  arriving on ward=2C baby developed x3 tiny non-blanching spots and so was =
>treated for meningococcal meningitis subsequently confirmed. baby was surpr=
>isingly well thruout and has made a quick and full recovery. =20
>
>when this happens=2C one always thinks "did i miss it?". in this case i can=
>not believe that the baby had a clinically diagnosable meningococcal illnes=
>s when i saw her nor if i had admitted the child-and there seemed no clinic=
>al reason to do so-do i really believe that the paeds would have found one =
>at that moment either=2C but knowing it and believing it is different. moth=
>er is ok about it=2C but if she wasnt=2C no amount of hard-nosed clinical e=
>xplanation is going to persuade her or her lawyers otherwise that a potenti=
>ally fatal illness had been missed=2C the emotional impact is simply too gr=
>eat.
>
>should this be notified as a significant event? and did you know that 1-in-=
>3 cases of meningitis results in a formal complaint?

Paul,

Provided of course that confidentiality hasn't been breached without 
consent, many thanks for sharing.  These accounts seem invaluable in 
reminding us that uncommon things happen and are very difficult.

You say the baby had meningococcal meningitis but presume you 
actually mean meningococcal septicaemia - hence the rash (with or 
without meningitis).

I'm sure you've looked at http://www.meningococcal.org/symptoms.html 
which reminds us that diarrhoea is a potential feature of 
meningococcal disease and 
http://www.nice.org.uk/nicemedia/pdf/CG47QuickRefGuide.pdf still 
appears extant.

You don't mention age of baby or exact level of fever which could be 
of interest.

Overall however every sympathy to you and to the family - even near 
misses are unpleasant.

Worth significant event reporting to any group you can trust to use 
the information wisely.

Julian 

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