Jan. 10, 2006 -- Kids with meningococcal disease may be saved by swift diagnosis and treatment, and new early warning signs could help.
Meningococcal disease is a life-threatening bacterial infection that can spread throughout the bloodstream and can also cause meningitis (infection of the lining and fluid of the brain and spinal cord).
Meningococcal disease is rare in the U.S. but is more common in developing countries, British researchers write in The Lancet.
The scientists included Matthew Thompson, MBChB, of the primary health department at England's University of Oxford.
The CDC recommends vaccinating adolescents to cut risk of meningitisvaccinating adolescents to cut risk of meningitis. Meningococcal disease can spread in close quarters (such as a college dorm).
New Early Warning Signs
The researchers report these possible early warning signs of meningococcal disease:
- Leg pain
- Cold hands and feet
- Abnormal skin color
Those symptoms may or may not show meningococcal disease; they could stem from other, much less serious illnesses.
Still, those signs were commonly seen in children and teens who had had meningococcal disease before the disease's classic signs (rash, headache, stiff neck, sensitivity to light, and impaired consciousness) appeared, write Thompson and colleagues.
Parents Speak From Experience
Thompson's study included information from medical records and completed questionnaires from parents of 448 British children who had been admitted to the hospital for meningococcal disease from 1997 to 1999.
The children ranged in age from 0-16 years; 103 had died of meningococcal disease. Most of the children developed blood infection (66%), 22% had meningitis, 12% had both.
Nearly six months after their children's illness, the parents completed surveys or were interviewed by the researchers. Thompson's team wanted to know what symptoms the kids had shown and when those symptoms had emerged.
The researchers also checked the children's medical records. In most cases, lab tests had been done that showed that the children had had meningococcal disease.Classic Signs Came Later
Most children started off with very common symptoms that aren't unique to meningococcal disease.
The kids sickened quickly over the next 24 hours. The time line was as follows:
- First four to six hours: Symptoms included fever, nausea, vomiting, headache, loss of appetite, sore throat, and irritability.
- Within the first 12 hours: New symptoms start (leg pain, cold hands and feet, and abnormal skin color).
- Between 12-15 hours: Classic signs of meningococcal disease start (rash, headache, stiff neck, sensitivity to light, and impaired consciousness).
Early Diagnosis Best
Thompson and colleagues don't want to needlessly alarm parents or doctors. Not every child with a fever or sore throat has meningococcal disease, they note.
The researchers didn't compare the children they studied to those with similar symptoms but without meningococcal disease. They also had to rely on parents' recall of what happened -- and when -- during a stressful time.
However, the scientists emphasize the importance of early diagnosis.
"Since infection can progress from initial symptoms to death within hours, individuals must be diagnosed as early as possible," they write.
When in Doubt, Follow Up
Barely half of the children they studied were sent to the hospital after first being seen by a doctor for their illness, the researchers note.
They advise doctors to see children again within four to six hours if the doctor is concerned about the child's condition but doesn't recommend hospitalization.
The follow-up visit should not be done the next day, Thompson's team says. A journal editorial backs that up.
Until more studies can be done, "doctors should be encouraged to schedule clinical review within four to six hours if early meningococcal disease cannot be ruled out at first contact," states the editorial.
The editorialists included Cristiana Nascimento-Carvalho of the pediatrics department in Brazil's Federal University of Bahia.