New advice for parents on spotting meningitis

PARENTS were given new advice yesterday to help them spot early signs of bacterial meningitis in their children.

Researchers highlighted symptoms of general infection, or sepsis - leg pain, cold hands and feet and an abnormally pale or mottled skin colour.

The “classic” signs of meningitis consist of a red rash combined with a headache, stiff neck, sensitivity to light and impaired consciousness.

But by the time these symptoms develop, children may be as little as two hours away from becoming critically ill.

Acting on the earlier indications would greatly speed up diagnosis and treatment and could save lives, it is believed.

Dr Matthew Thomson from Oxford University led a team investigating 448 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% of the children developed identifiable early sepsis symptoms in just eight hours.

The researchers wrote in an online edition of The Lancet medical journal, published yesterday: “We believe our evidence is sufficiently robust to argue that we need a diagnostic paradigm shift. 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. Leg pain, cold hands and feet, and abnormal skin colour are rarely reported by parents to a primary care doctor, and are therefore likely to have high diagnostic value.”

The researchers analysed answers to questionnaires given to parents and scoured medical records.

Of the total number of children, all aged 16 and younger, 103 died and 345 survived. Only half the children were sent to hospital after the first time they were seen by a doctor.

Meningitis is an inflammation of the linings of the brain and spinal cord. Meningococcal disease is the most common infectious cause of death in Ireland in people under 20 years of age.

The meningitis C vaccination programme has been in place in Ireland since 2000 and has led to a 96% reduction in this strain of the disease. However, meningitis B, for which there is no vaccine, now accounts for the vast majority of meningitis cases.

In many cases, children are only admitted to hospital after their condition is initially misdiagnosed, said the researchers.

Generally, doctors look for the classic symptoms of rash, meningism - headaches, stiff neck and light sensitivity - and impaired consciousness.

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

Also in The Lancet, two experts from Brazil said lives could be saved if the recommendations were adopted.

Cristiana Nascimento-Carvalho and Otavio Moreno-Carvalho, from the Federal University of Bahia, wrote: “The recognition of early signs of meningococcal disease could reduce subsequent mortality.”