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Meningitis

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The press recently reported on the tragic case of a promising young teenager who died as a result of a new particularly deadly strain of meningitis.   Edward Saunders, 18 years old, died within 12 hours of first complaining of a headache and within 3 hours of being admitted Hospital.  Time is of the essence in diagnosing and, where possible, successfully treating meningitis.

http://www.dailymail.co.uk/health/article-3223548/The-jab-save-teenager-terrifying-disease-stole-just-12-hours-brutal-meningitis-strain-kills-son-grieving-mother-backs-new-vaccination-drive.html

What is Meningitis?

Meningitis is an infection of the protective membranes (the meninges) that surround the brain and spinal cord. The resulting inflammation can cause damage to the brain and the nerves.

Types of Meningitis

The infection that causes meningitis can be viral or bacterial. The more common cause is viral. For example, before vaccinations were available, mumps and measles caused a lot of meningitis outbreaks.  It is now usually caused by enteroviruses, responsible for sore throats, colds and flu-like illnesses. Children, who are the main transmitters of enteroviruses, and people with weakened immune systems, are most likely to be affected but, thankfully, usually make full recoveries.

Bacterial meningitis is usually more severe and dangerous than viral meningitis and occurs when bacteria enters the blood stream and travels to the brain and spinal column.  For example:

  • Streptococcus pneumonia, the most common cause of bacterial meningitis (known as pneumococcal meningitis) which can also cause ear infections and pneumonia; and
  • Neisseria meningitides, another leading cause of bacterial meningitis (known as meningococcal meningitis) which occurs when bacteria from an upper respiratory infection enters the bloodstream.

Symptoms of Bacterial Meningitis

The symptoms of bacterial meningitis are not always easy to identify and can be mistaken for other illnesses, such as flu.  There are also different symptoms depending on the age of the patient.  Full information can be found on the NHS Choices website and a doctor should always be consulted.

For babies and children under the age of 5, the symptoms, in no specific order, may include:

  • A high fever with cold hands and feet
  • Vomiting and poor feeding
  • Agitation and reluctance to be handled
  • Drowsy, floppy and unresponsive
  • Grunting or rapid breathing
  • High-pitched or moaning cry
  • Pale blotchy skin and, sometimes, a red rash that doesn’t fade when a glass is rolled over it
  • Tense, bulging fontanelle
  • Stiff neck and dislike to bright lights
  • Convulsions or seizures

In older children and adult the symptoms, in no specific order, may include:

  • A high fever with cold hands and feet
  • Drowsiness and difficulty waking up
  • Confusion and irritability
  • Severe muscle pain
  • Drowsy, floppy and unresponsive
  • Pale, blotchy skin and possibly, although not always, a distinctive rash
  • A severe headache
  • A stiff neck
  • Sensitivity to light
  • Convulsions or seizures

A lot of these symptoms are caused because of the increased pressure in the brain as a result of the inflammation and swelling in the meninges and the brain tissue due to the infection.

Treatment

Antibiotics are used to treat bacterial meningitis.  It is crucial that these are given early on in order to try and stop and reduce the inflammation and swelling and minimise any injury to the brain.  Doctors will carry out tests to diagnose meningitis including blood tests and possibly a lumbar puncture.  A lumbar puncture is useful and important because it tests the content of the fluid that fills the meninges (cerebrospinal fluid) which is designed to bathe and cushion the brain.  This test can determine which germ in this fluid is causing the illness and, therefore, the best antibiotics to try and combat this.  Steroids may also be given to try and help reduce the inflammation in the brain.

New strains of meningitis, such as Meningitis W, which claimed the life of Edward Saunders, can cause unusual symptoms not normally associated with meningitis.  Dr Nelly Ninis, Consultant Paediatrician in London, says that: ‘this makes it difficult for doctors to spot’.  New strains may also be more resistant to antibiotic treatment.  Vaccinations against this strain of meningitis have already begun with teenagers being targeted because of their vulnerability.  Vaccinations against other more common types of meningitis are routinely offered under the NHS childhood vaccination programme.  http://www.huffingtonpost.co.uk/2015/07/07/teens-at-risk-meningitis-w-first-vaccinations_n_7743672.html

Antibiotics are not used to treat viral meningitis because they do not have any effect on viruses.  Because viral meningitis is usually less severe, rest and fluids is often sufficient treatment.

Injuries

If treatment is not given promptly, bacterial meningitis can be fatal, at any age.

Hearing loss is the most common physical after effect, particularly in children who have suffered from pneumococcal meningitis.  This type of injury occurs early in the inflammation process and cannot always be prevented, even with prompt diagnosis and treatment.  Brain damage is another possibility that can result in cerebral palsy, paralysis, learning difficulties and behavioural and emotional difficulties.  Psychological problems often present very subtly in young children (temper tantrums and being clingy, for example) which then develop and become more apparent with age.

Viral meningitis is usually a lot less severe and does not typically lead to long term injuries.

Clinical Negligence Claims

Clinical negligence claims in this area usually involve a delay in diagnosing bacterial meningitis resulting in a lost window of opportunity to effectively treat it with antibiotics.  Because the symptoms are similar to other illnesses, doctors may not take the investigative steps required to rule out meningitis; for example, a GP may not refer a child to Hospital for paediatric review and, instead, take a wait and see approach.  A paediatrician may also not carry out blood tests, a lumbar puncture or chest x-ray (if pneumonia is suspected) if they do not consider meningitis a risk.  In my experience, the key is for doctors to listen to the parent’s concerns about the history of the child’s illness; particularly, the chronology of onset of the more subtle symptoms,  such as grunting, poor feeding and drowsiness.

Doctors should always have an index of suspicion of meningitis, especially if parents report ongoing and prolonged possible meningitis symptoms.  Statistics show that clinical negligence claims for delayed diagnosis of bacterial meningitis are on the increase, especially against GPs.  Because the resulting injuries can be so severe, compensation is often in the millions of pounds to account for the future needs of the child, including care and support.

If you think you, or your child, may have suffered an injury as a result of negligent medical treatment and would like to speak with a member of the Lester Morrill clinical negligence team, please call on 0113 245 8549 or contact us by email athelp@lmlaw.co.uk .

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