Clinical recognition of meningococcal disease in children and adolescents

被引:329
作者
Thompson, MJ [1 ]
Ninis, N
Perera, R
Mayon-White, R
Phillips, C
Bailey, L
Harnden, A
Mant, D
Levin, M
机构
[1] Univ Oxford, Dept Primary Hlth Care, Oxford, England
[2] Univ London Imperial Coll Sci & Technol, Fac Med, Dept Paediat, London, England
基金
英国医学研究理事会;
关键词
D O I
10.1016/S0140-6736(06)67932-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Meningococcal disease is a rapidly progressive childhood infection of global importance. To our knowledge, no systematic quantitative research exists into the occurrence of symptoms before admission to hospital. Methods Data were obtained from questionnaires answered by parents and from primary-care records for the course of illness before admission to hospital in 448 children (103 fatal, 345 non-fatal), aged 16 years or younger, with meningococcal disease. In 373 cases, diagnosis was confirmed with microbiological techniques. The rest of the children were included because they had a purpuric rash, and either meningitis or evidence of septicaemic shock. Results were standardised to UK case-fatality rates. Findings The time-window for clinical diagnosis was narrow. Most children had only non-specific symptoms in the first 4-6 h, but were close to death by 24 h. Only 165 (51%) children were sent to hospital after the first consultation. The classic features of haemorrhagic rash, meningism, and impaired consciousness developed late (median onset 13-22 h). By contrast, 72% of children had early symptoms of sepsis (leg pains, cold hands and feet, abnormal skin colour) that first developed at a median time of 8 h, much earlier than the median time to hospital admission of 19 h. Interpretation Classic clinical features of meningococcal disease appear late in the illness. Recognising early symptoms of sepsis could increase the proportion of children identified by primary-care clinicians and shorten the time to hospital admission. The framework within which meningococcal disease is diagnosed should be changed to emphasise identification of these early symptoms by parents and clinicians.
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页码:397 / 403
页数:7
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