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New guidelines for the diagnosis and management of suspected meningitis in adults in the UK

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    A blog considering new published guidelines relating to the management of suspected meningitis in adults across the UK, and why prompt diagnosis and treatment of meningitis is so important.

    By Kerstin Kubiak

Earlier this year the Journal of Infection published new guidelines for the diagnosis and treatment of meningitis and meningococcal septicaemia in adults in the UK.  These guidelines have been devised by a group of medical experts in the fields of infection, neurology, intensive care, acute medicine and public health, together with the Meningitis Research Foundation (MRF), with the aim of seeking to prevent late diagnosis of the disease and improving outcomes for patients.

What is meningitis?

The MRF definition of meningitis and septicaemia is:

Meningitis is inflammation of the lining around the brain and spinal cord – the meninges. Septicaemia is blood poisoning caused by the same germs and is the more life threatening form of the disease.”

Meningitis can be bacterial or viral, with meningococcal bacterial being the more serious and reported to be the cause of most cases of meningitis and/or septicaemia in the UK.

Whilst many people make a full recovery from meningitis and septicaemia, in other cases patients can suffer long-term adverse effects, including loss of limbs (amputation), hearing loss and cognitive impairments.  In severe cases patients can die from the disease.

Why was there a need for new guidelines for management of suspected meningitis and septicaemia in adults?

It is reported by the MRF that whilst cases of meningitis and septicaemia in children appear to be reducing, the same cannot be said for adults and a study of adult patients with meningitis between 2004 and 2011 revealed a 3% increase in the number of patients in the age group over 65, each year.

It is well established and reported by the MRF that, in respect of meningitis and septicaemia, “prompt recognition and treatment are essential as delays in recognising the disease and commencing appropriate treatment can have disastrous consequences”.

As a result, new guidelines have been devised, based on updated research and clinical information, to assist with preventing delays in such patients being diagnosed and receiving treatment wherever they are in the UK, and therefore aiming to improve outcomes for those patients.

I have also written on the topic of meningitis previously in 2013 from a medical negligence perspective following reports of increasing numbers of medical negligence claims against GPs in particular relating to misdiagnosis and delayed diagnosis of meningitis, causing serious injuries to patients and leading to millions of pounds being paid out in compensation.

What are the new guidelines?

The guidelines are aimed at assisting clinical practitioners with the management of patients with suspected meningitis and septicaemia from their pre-hospital care through to post-discharge from hospital following treatment, and are therefore comprehensive.

The new guidelines also include a summary algorithm/flowchart which is to be distributed by the MRF to every hospital in the UK to assist with emergency management of suspected meningitis and septicaemia in adults.  The algorithm makes clear that early recognition of meningitis and sepsis is crucial and that the diagnosis should be considered if a patient presents with any of the following symptoms:

  • Headache;
  • Fever;
  • Altered consciousness;
  • Neck stiffness;
  • Rash;
  • Seizures;
  • Shock.

The algorithm then recommends various options for treatment depending on whether or not the patient is presenting with or without signs of shock or severe sepsis, the latter being more time critical.

Our experience

My colleagues and I have acted for a number of patients, both adults and children, who have suffered serious injuries due to late diagnosis of meningitis as a result of negligence in their care either in a primary care setting (when seeing their GP) or later when attending hospital.  Having seen the devastating and life-long impact such injuries, I was very pleased to read of these new guidelines and hope that these will provide a helpful and beneficial reference tool for all clinicians across the UK and lead to a reduction in the number of adult patients with late diagnosis of meningitis and septicaemia.

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