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 We all have had such bad experiences. Our latest (last spring) was a 4 y/o child seen by his Family Physician at mid morning with fever of recent onset, recommended an antibiotic treatment that the family did not follow. The child was seen around noon by a Paediatrician who sent the child to a hospital for further evaluation. Admitted to the ER was seen by two certified Ped EM  doctors and a set of blood test were run, all of them returned normal. By 16.00 h. the child was asymptomatic and afebrile and was sent home to return in case of any changes or worsening.

He did; this time to our ER, at 23.00 h. covered with ecchymotic spots, in shock and moribund. And died 30 minutes afterwards despite all the resuscitation measures taken. Blood cultures taken at the other hospital ER eventually grew n. meningitis typeB. The family said the spots had appeared within the previous hour... but they are suing everybody involved in the case.

Meningococcal disease will continue to kill children despite proper care. It is a bad enemy. Vaccination, when available, would be the answer. N. meningitis typeC is now compulsory in Catalonia. 


Xavier Allué, Paediatric service

Hospital universitari de Tarragona Joan XXIII

Tarragona ,Spain.


-----Mensaje original-----
De: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] En nombre de Abdul Nasir
Enviado el: martes, 07 de noviembre de 2006 22:32
Para: [log in to unmask]
Asunto: Re: meningococcemia

Hi simnte

i wanted to tell you one interesting story ..it was 10;00 pm when we got a feverish 39 C  child of 4 years in our ER , the pediatrician called and attended him  she ordered for WBC which was 5.5 , she gave him naalgsics and augmentine and discharged after fever came down....

  By 4;00 AM the child had been brought dead to ER with full marks of petechial hemmorahge which pathognomonic of Meningococcemia...

  It was a big issua that how could a doctor expecting  meningococemia in a child with fever !!!

In fact till now i couldnt find an answer inspite that our hospital did CME regarding that case and said that onlt around 5% of febrile children will go into Meningococemia, and this is very rarely to be expcted  to appear!

Nowadays, i used to either admit or do at least CBC for any febrile child even without any bad signs...i still feel hezitated to discharge him , scared will get him back as DEAD .

 Any one can help me by one guidline or rules for that thing?

thx
Nasser/

For more information, send mail to [log in to unmask] with the message: info PED-EM-L The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html



For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html