Diagnostic problems with meningococcal disease in general practice

Sørensen, Henrik Toft; Møller-Petersen, J; Krarup, Henrik; Pedersen, Helena; Hansen, H; Hamburger, H. J.

doi:10.1016/0895-4356(92)90169-n

Cited by 20 publications

(8 citation statements)

References 7 publications

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“…Because of the scarcity of literature in this specific field, text and opinion literature including expert opinion, commentaries, reviews and narratives were also eligible for inclusion, as these constituted the best available evidence 17. The starting search date for papers was 1992, which was the year of publication of several of the seminal papers investigating the use of antibiotics for IMD in the community setting 18–22. There were no language restrictions on the search or screening processes; Google Translate was used to perform a translation of the title and abstract of any sources if they were located in the searches and appeared to possibly fit the inclusion criteria.…”

Section: Methodsmentioning

confidence: 99%

Care of the patient with invasive meningococcal disease by prehospital emergency medical service clinicians: a scoping review

et al. 2020

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ObjectiveThe objective of this scoping review is to systematically map the literature to identify the scope, depth, key concepts and gaps in the evidence regarding care of the patient with invasive meningococcal disease by emergency medical service (EMS) clinicians.DesignScoping review. This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guideline.Eligibility criteriaSources which focused on patients with invasive meningococcal disease (population), where the care of EMS clinicians was the focus (concept), in EMS systems worldwide (context) were eligible for inclusion.Search strategyThis review utilised a comprehensive search strategy including MEDLINE, Embase, Emcare, CINAHL, Scopus, Web of Science, Google Scholar and ‘grey’ literature databases from 1992 to January 2019. The search also included a Google search, a hand-search of relevant journals, screening of reference lists, contact with authors of included sources and use of social media in an attempt to locate all sources of evidence which fit the inclusion criteria of the review. Two reviewers independently screened sources for inclusion.ResultsThe search yielded 1803 unique records, of which 10 were included in the synthesis. No original research papers were identified, with all sources classed as either clinical audit or text and opinion literature. The dominant concept throughout the literature is that early antibiotic therapy is critical in the treatment of invasive meningococcal disease.ConclusionsOverall, there is a very narrow scope and shallow depth of literature on the topic of interest. There are gaps in the evidence regarding the care of the patient with invasive meningococcal disease by EMS clinicians. Despite these shortfalls, current consensus-based guidelines should direct clinical practice. Further research is planned to bridge the gaps in knowledge to support best practice.

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Section: Methodsmentioning

confidence: 99%

Care of the patient with invasive meningococcal disease by prehospital emergency medical service clinicians: a scoping review

et al. 2020

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“…[21] This rash is seen in up to 38% of cases of meningococcal disease [22] and significantly decreases the chance of a GP diagnosing meningococcal disease. [18] …”

Section: Recognitionmentioning

confidence: 97%

“…[11] A GP is significantly more likely to make a diagnosis if specific signs such as neck stiffness or petechiae are present. [18,20] However, only 50% of cases have a haemorrhagic rash when seen by a GP. [11,20] If these signs are not recognised the delay in diagnosis may contribute to a fatal outcome.…”

Section: Recognitionmentioning

confidence: 99%

“…[17] GPs correctly diagnose patients with meningococcal disease in 70 to 80% of the cases that they admit. [17][18][19][20] However, around 50% of cases are seen by a doctor but not admitted to hospital during the early stages of their illness [13,18] because the symptoms are nonspecific. [11] A GP is significantly more likely to make a diagnosis if specific signs such as neck stiffness or petechiae are present.…”

Section: Recognitionmentioning

confidence: 99%

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Recognition, Treatment and Complications of Meningococcal Disease

Riordan

Thomson

1999

Pediatric Drugs

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Meningococcal disease remains a major cause of death in young children. A decrease in mortality requires recognition and treatment of the disease at a number of stages in the illness. Life-threatening meningococcal disease usually presents as septicaemia rather than meningitis. The cardinal feature of meningococcal septicaemia is the purpuric rash. Many parents recognise the rash and seek medical advice because of it. When primary care physicians recognise the rash, the administration of parenteral penicillin may decrease mortality. However, antibacterials are not given promptly if there is no rash or if the disease presents in an atypical form. In hospital, antibacterial therapy with a third-generation cephalosporin should be given. Disease severity needs to be assessed by a valid method, such as the Glasgow Meningococcal Septicaemia Prognostic Score (GMSPS). This can identify those patients who need intensive care and/or might benefit from new therapies. The 2 life-threatening complications are septic shock and meningoencephalitis with raised intracranial pressure. Despite numerous case reports of success with potential new treatments, none has been proven safe and/or effective by controlled trials. Although it is tempting to focus on new treatments, the early recognition of severe meningococcal disease by parents, primary care physicians and junior hospital doctors is equally, if not more, important as a potential means of decreasing mortality.

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“…Searches will be restricted by publication date, commencing from 1992. This was the year of several publications regarding the use of antibiotic therapy for IMD in primary care settings (23,(26)(27)(28)55). It is highly unlikely that there will be any relevant published literature earlier than this date, as the first EMS CPGs for IMD were not released until 2000 (44).…”

Section: Search Strategymentioning

confidence: 99%

Care of the Patient with Invasive Meningococcal Disease by Emergency Medical Service Clinicians: A Scoping Review Protocol

Pearce

Peters

May

et al. 2019

Australasian Journal of Paramedicine

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BackgroundInvasive meningococcal disease (IMD) is a rare but potentially fatal disease. It can rapidly progress within minutes to hours and carries a significant burden of disease worldwide. The role of emergency medical service (EMS) clinicians in providing early care for the patient with IMD is important, but the literature regarding the pre-hospital phase of care is sparse.AimThe aim of this scoping review is to systematically map the literature to identify the scope, depth and key concepts in the evidence, and to identify gaps in knowledge regarding the care of the patient with IMD by EMS clinicians.MethodsA comprehensive electronic search strategy will be used to locate sources of evidence that fit the inclusion criteria of the study. Data will be extracted, charted and reported in accordance with current best practice for scoping reviews.DiscussionThis protocol provides the framework for the first scoping review to identify the scope, depth and key concepts in the evidence, and to identify gaps in knowledge regarding the care of the patient with IMD by EMS clinicians. The review report will present the current state of knowledge, inform clinical practice guideline development and identify gaps in the evidence requiring further research.Scoping review registration:The protocol for this scoping review was registered prospectively with the Open Science Framework (https://osf.io/z639u/).

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Diagnostic problems with meningococcal disease in general practice

Cited by 20 publications

References 7 publications

Care of the patient with invasive meningococcal disease by prehospital emergency medical service clinicians: a scoping review

Care of the patient with invasive meningococcal disease by prehospital emergency medical service clinicians: a scoping review

Recognition, Treatment and Complications of Meningococcal Disease

Care of the Patient with Invasive Meningococcal Disease by Emergency Medical Service Clinicians: A Scoping Review Protocol

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