How to miss meningitis

[EzeΤΡΟΛ]

Στην παρακάτω καταχώρηση του NHS Blog Doctor, ο GP συντάκτης παραπονείται ότι το Ην. Βασίλειο είναι  "...η μοναδική χώρα στον κόσμο όπου ο καθένας μπορεί να σηκώσει το ακουστικό και να απαιτήσει ένα γιατρό στο σπίτι του για οποιαδήποτε κατάσταση, οσοδήποτε ασήμαντη, και με αυτή του την κίνηση  να μεταθέσει την ευθύνη του αποτελέσματος της ασθένειας στον ιατρό." Χμμ... η μόνη χώρα; Μήπως ξέχασε την Ελ;

"This is the incubus (στοιχειό, εφιάλτης, μπελάς) of general practice in the UK. There is no other country in the world in which you can you pick up the telephone and summon a doctor to your house for any condition, however trivial, and by so doing immediately transfer the responsibility for the outcome of the illness onto the doctor."

Παρακάτω, καταλήγει ότι υπάρχει μια μερίδα ανθρώπων που καταβάλλουν περισσότερη σκέψη στο να καλέσουν μια πίτσα στο σπίτι τους παρά τον γιατρό. "Φυσικό, αφού την πίτσα την πληρώνεις"!
"Some people put more thought into ordering a take away Pizza than they do into calling a doctor. Of course you have to pay for the Pizza."

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[EzeΤΡΟΛ]

Πόσο εύκολο είναι να διαγνώσουμε έγκαιρα  τη μηνιγγίτιδα; Πόσο φταίει ο γιατρός που του διέλαθε η πρώιμη   διάγνωση της; Σύμφωνα με το συντάκτη του παρακάτω άρθρου, φταίει όσο φταίνε και οι γιατροί που δεν διέγνωσαν έγκαιρα ότι ο Α. Χίτλερ έπασχε από ψυχική νόσο που θα οδηγούσε την υφήλιο στον Β' Παγκ. Πόλεμο.

"Τα περισσότερα παιδιά εμφανίζουν μη ειδικά συμπτώματα εντός των πρώτων 4 με 6 ωρών, αλλά φτάνουν κοντά στο θάνατο σε 24 ώρες από τη λοίμωξη. Τα κλασσικά συμπτώματα - κεφαλαλγία, αυχενική δυσκαμψία, φωτοευαισθησία και διαταραχή της συνείδησης καθώς και το εξάνθημα - εμφανίζονται αργά, μεταξύ 13ης και 24ης ώρας κατά μέσο όρο."

Ακόμη χειρότερα;
" ...τα κλασσικά τρία σημεία της μηνιγγίτιδας είναι πυρετός, αυχενική δυσκαμψία και φωτοφοβία. Και τα τρία σημεία μπορεί να απουσιάζουν."

Άραγε φταίει ο γιατρός που δεν μπορεί να την προβλέψει; Και αν όχι, ποιός φταίει;

"Η απάντηση είναι: η ναϊσσέρια η μηνιγγιτιδοκοκκική. Είναι ένα έξυπνο μικρόβιο. Δεν αποκαλύπτει τον εαυτό της μέχρι να εδραιωθεί για τα καλά. Η διάγνωση της μηνιγγίτιδας γίνεται ευχερής μόνο αφότου εμφανιστούν η αυχενική δυσκαμψία, η φωτοφοβία και το αιμορραγικό εξάνθημα."

Εμείς το ξέρουμε. Άραγε οι γονείς, η κοινή γνώμη και τα ΜΜΕ το ξέρoυν;


British GPs blamed for not preventing the Second World War
posted by Dr John Crippen

Adolf Hitler - GPs failed to spot that he was dangerous

Research historians at Cambridge University have shown that there was evidence as early as 1930 that Adolf Hitler was exhibiting psychopathic tendencies and may indeed have been psychotic. If only GPs had been more alert and picked up the early signs, they could have warned the politicians and WW11 could have been averted.

Having written an article yesterday about meningitis, it was an odd co-incidence to wake up to the Radio 4 Today programme discussing some research in the Lancet about the “identification” of early warning signs for meningitis.

As always, when scientists in laboratories, many of whom have not seen a patient for twenty years, "discover" something which is new to them, they make sanctimonious remarks about GPs needing “more training”.

Hardly a day goes by without something in the media which starts: “Most GPs don’t know……” or “GPs need to learn….”

So what is this latest tirade about? The researchers did a retrospective analysis of 448 children with meningitis. They questioned the patients. Something along the lines of:

“Given your knowledge of World War 11, was there anything about Mr Hitler’s behaviour that in retrospect might have given cause for concern?”

Or, in this case, “Given that your children had meningitis, and thinking carefully about the symptoms they exhibited, what else can you remember?”

Let me quote directly from the paper:

“Most of the children showed only non-specific symptoms in the first four to six hours, but were close to death 24 hours after infection. The 'classic' symptoms - headache, stiff neck, sensitivity to light and impaired consciousness as well as rash - developed late, between 13 to 22 hours on average.”

Note in particular that “most of the children showed only non-specific symptoms…”. (my emphasis). Quite. Non-specific symptoms.

The scientists in the ivory tower have only just have realised this. Welcome to the real world. It is not new

One of the standard medical texts on emergency medicine, written over thirty years ago says:

“…the classic three signs of meningitis are temperature, neck stiffness and photophobia (fear of bright lights). All three signs may be absent.”

In my large practice, we see between 50 and 100 children a day with “minor” illnesses; coughs, colds, temperatures, malaise, or “he is a bit off colour doctor”. You cannot give a single one of them a guarantee that a few hours later they will not be critically ill with meningitis. I cannot give you a guarantee that I will not be so afflicted by teatime.

So shall we give 50 to 100 children a day an injection of intravenous penicillin and send them into hospital "just in case"? I do not think so.

And why is it always GPs who are battered? Many of these patients will nowadays call NHS Direct to get telephone advice from a nurse with a book of protocols. And Casualty officers are the most inexperienced doctors in the health service. They do not have that “sixth sense” that enables you, occasionally, to spot an ill child early in the course of an illness. And the Health Visitors? And the practice nurses? And what about school teachers? They know children well. They see them all day… and so on and so on.

This is the "blame culture". The mortality and morbidly rate from meningococal meningitis is higher than we like. Ergo it is someone’s fault and the usual person to blame is the GP. It is not the GP's fault. Is not the parents' fault. Or the teachers. Or the nurses. Or the casualty officers.

The fault is this: neisseria meningitis.

It is a clever bug. It doesn’t show itself until well established. The diagnosis of meningitis is easy once the neck stiffness, the photophobia, and the florid septicaemic rash has appeared.

Until then it is not.

So what it is the most important sign that I, not in my ivory tower, would put to parent with a hot child? Look for sudden and unexpected deterioration. If, as and when that happens, seek immediate help.

In the meantime, let us all be alert, but please, please, can we stop blaming each other?

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