Tags Posts tagged with "septicaemia"

septicaemia

Image: ©Lightworks/Veer #9784987

It’s that time of year – parents are sending their offspring to university, worrying how said child is going to cope with washing, ironing, cooking and hangovers. What rarely crosses their mind is the possibility of meningitis.

Usually perceived as a disease of early childhood, meningitis is classed as either bacterial or viral [1]. Bacterial meningococcal disease is caused by the bacterium Neisseria meningitides, (common types being A, B, C, W, X and Y) [2] and causes serious and life-threatening diseases including meningitis.

While the overall incidence is dropping relative to the take-up of the meningitis C, pneumococcal, and MMR vaccines, succumbing to a viral or bacterial episode is not uncommon, particularly in places where people are in prolonged close contact, such as halls of residence. Kissing and coughing can also spread the disease. A study [3] of first year university students which aimed to determine the rates of, and risk factors for, meningococcal carriage and acquisition, found that:

  • Carriage rates for meningococci increased rapidly in the first term among students living in catered halls; the average rate during the first week was 13.9% (October), increasing to 31.0% in November and 34.2% by December.
  • Independent associations for acquisition included frequency of visits to the hall bar, smoking, attending night clubs, kissing and being male. Lower rates of acquisition were found in female only halls [3]

Viral meningitis is considered to be less serious than bacterial with fewer long-term effects. However, a survey commissioned by the Meningitis Trust in 2012 suggested that 97% of respondents had been left with long-term effects such as exhaustion, headaches and memory loss [4]. Bacterial meningitis is usually serious and requires immediate medical attention – death is not uncommon. In the long-term, it can cause [5]:

  • Memory problems
  • Coordination difficulties or weakness
  • Residual headaches
  • Hearing/speech problems
  • Epilepsy
  • Sight problems

Unfortunately, the signs and symptoms of meningococcal infection often mimic those of student life in general. They include:

  • Fever and/or vomiting
  • Cold hands/feet, shivers
  • Pain in limbs, joints or muscles
  • Pallor
  • Breathlessness or fast breathing
  • Sleepiness, hard to wake
  • Appearing vacant, or confused, or delirious
  • Rash/dislike of bright lights

Thus, those going to university should be aware that these symptoms may be a cause for concern.

Vaccination

Approximately 90% of cases of meningococcal disease in the UK are caused by type B disease (MenB) [2]. Meningococcal W (MenW) is an aggressive bacterial strain (ST-11), the numbers of which have been increasing – in the UK in 2005 22 cases were identified (1-2% of meningococcal cases), in 2014, the number had risen to 117(15%) [5]. MenW has a particularly high death rate – 13% compared to 5-10% in other cases [5]. University students in particular have been affected [4].

As a result, the Joint Committee on Vaccination and Immunisation (JCVI) reviewed the outbreak in detail and concluded that as this increase was likely to continue unless action is taken. They therefore advised that 14 to 18 year olds should be immunised against meningococcal group W (MenW). Public Health England (PHE) launched the MenACWY vaccination programme in June 2015. Starting with the vaccination of those aged 17-19 years, the aim is to protect against the four meningococcal strains that cause meningitis or septicaemia, including MenW [6].

The vaccines used will be Nimenrix® or Menveo®.  Both are conjugate vaccines and come in a powder and solvent for solution for injection in pre-filled syringe [7]. They contain small amounts of polysaccharides extracted from the A, C, W135 and Y groups of the N. meningitidis bacterium, which have been attached to a protein carrier, tetanus toxoid, improving the immune response to the vaccine [8].

Conclusion

Both students and clinicians need to be aware of the risks of contagion while at university, particularly in the first terms. Early recognition of the signs and symptoms is key.

If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.

References

  1. NHS Choices. Meningitis. 2015 Available at: http://www.nhs.uk/Conditions/Meningitis/Pages/Introduction.aspx Accessed August 2015
  2. University of Oxford Vaccine Knowledge Project. Meningococcal disease. 2015. http://www.ovg.ox.ac.uk/meningococcal-disease Accessed August 2015
  3. Neal KR, Nguyen-Van-Tam JS, Jeffrey N, Slack RCB et al. Changing carriage rate of Neisseria meningitidis among university students during the first week of term: cross sectional study. BMJ. 2000. 320:846-840. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27326/pdf/846.pdf Accessed August 2015
  4. Meningitis Now. Viral Meningitis, the facts. Meningitis Now. 2015. http://www.nhs.uk/ipgmedia/National/Meningitis%20Now/assets/ViralMeningitis.pdf Accessed August 2015
  5. Meningitis Research Foundation. MenW. Meningococcal W meningitis and septicaemia: a new, virulent strain. 2015. Available at: http://www.meningitis.org/menw Accessed August 2015
  6. Public Health England. New meningococcal vaccination programme expected to save lives. 2015. Available at: https://www.gov.uk/government/news/new-meningococcal-vaccination-programme-expected-to-save-lives Accessed August 2015
  7. European Medicines Agency. Nimenrix®. 2015. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/002226/human_med_001548.jsp&mid=WC0b01ac058001d124 Accessed August 2015
  8. European Medicines Agency. Menveo®. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/001095/human_med_001323.jsp&mid=WC0b01ac058001d124 Accessed August 2015

Resources

Meningitis Research Foundation. Meningococcal meningitis and septicaemia. Diagnosis and treatment in general practice. 2014. Available at: http://www.meningitis.org/assets/x/50631

Meningitis Research Foundation. Management of Meningococcal Disease in Children and Young People. 2015. Available at: http://www.meningitis.org/assets/x/50150 Accessed August 2015

Antimicrobial Research Collaborative (ARC) recommends CRE screening as a priority for admissions to high-risk specialities

Image: ©nata-lunata/Shutterstock #220986358

The Gram-negative bacterial family of Enterobacteriaceae, includes the species Klebsiella, Enterobacter, and Escherichia. These bacteria can cause opportunistic wound infections, gastroenteritis, pneumonia and septicaemia, particularly in hospital patients, including post-operative patients. Carbapenem-resistant Enterobacteriaceae (CRE) is now a serious concern for the NHS (1).

In 2009, reports first emerged from the USA that these new hospital-acquired, antibiotic-resistant bacteria, had caused death in hospital patients. A prediction was made at this time that CRE could be even harder to eradicate than methicillin-resistant Staphylococcus aureus (MRSA) or antibiotic-resistant Clostridium difficile.

Following reports of cases of CRE in more than a dozen hospitals in England and Scotland in 2009, the then Health Protection Agency (HPA) (now Public Health England) issued a warning about what it called, ‘a notable public health risk’(1). Initially, CRE was thought to be imported from patients having had surgery in India and CRE was considered to be a consequence of the increasing number of UK patients travelling abroad for surgery each year (> 100,000 in 2013) (2).

In 2015, a joint collaboration between Imperial College Healthcare NHS Trust, Imperial College Academic Health Sciences Centre (AHSC) and Imperial College London has created a new multidisciplinary research group, the Antimicrobial Research Collaborative (ARC) (3,4). The aim of the ARC is to translate research findings into new infection prevention strategies. This initiative will have an important role in addressing the problem of antimicrobial resistance (AMR).

As part of the ARC collaboration, in April 2015 researchers lead by Professor Alison Holmes, Director of the National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU), Imperial College London, published their review of current CRE screening strategies in the Journal of Infection(5,6). Among the findings of this study, they noted that admissions to high-risk specialties were likely to have higher CRE prevalence rates and that the higher prevalence of CRE resulted in higher detection rates and lower false-positivity rates (6). These researchers have recommended that CRE screening should be prioritised for hospital admissions to high-risk specialties (6).

The CRE strains are resistant to all the standard antibiotics now used in the NHS. Furthermore, some of these resistant bacteria have been shown to survive in hospital environments, such as table surfaces and door handles.

In May 2015, a publication by Weber and colleagues in the US, in the journal Infection Control & Hospital Epidemiology (ICHE) (published online in Feb 2015), reported that CRE-infected patients contaminated the environmental surfaces of hospital rooms in 8.4% of cases, but at low levels (7). Three species of CRE, Enterobacter, Klebsiella, and Escherichia, survived poorly, with 15% survival after 24 hours and 0% survival after 72 hours (7).

The survival of enteric organisms, such as CRE, is likely to be less than the survival of MRSA on hospital surfaces, due to differences in the structure of the bacterial cell capsule. The ICHE study shows that the levels of contamination and survival are high enough to be important in terms of CRE transmission (7).

In conclusion, carbapenem-resistant Enterobacteriaceae (CRE) are an important group of infections for the new multidisciplinary antimicrobial resistance (AMR) teams to target. Despite their reported limited growth and survival on hospital surfaces, the increasing number of reported cases supports the view that now is not the time to be complacent about hospital infection control.

If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.

References

(1) Public Health England. https://www.gov.uk/government/organisations/public-health-england Accessed June 16, 2015

(2) Office for National Statistics, Travel Tends 2013. http://www.ons.gov.uk/ons/dcp171776_361237.pdf Accessed June 16, 2015

(3) Imperial College Healthcare NHS Trust. http://www.imperial.nhs.uk Accessed June 16, 2015

(4) The Antimicrobial Research Collaborative (ARC), Imperial College, London. http://www.imperial.ac.uk/arc Accessed June 16, 2015

(5) The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London. http://www1.imperial.ac.uk/hpruantimicrobialresistance/ Accessed June 16, 2015

(6) Venanzio V, Gharbi M, Moore LS, Robotham J, Davies F, Brannigan E, Galletly T, Holmes AH. Screening suspected cases for carbapenemase-producing Enterobacteriaceae, inclusion criteria and demand. J Inf 2015;pii:S0163-4453(15)00197-8. http://www.ncbi.nlm.nih.gov/pubmed/26070742 Accessed June 16, 2015

(7) Weber DJ, Rutala WA, Kanamori H, Gergen MF, Sickbert-Bennett EE. Carbapenem-resistant Enterobacteriaceae: frequency of hospital room contamination and survival on various inoculated surfaces. Infect Control Hosp Epidemiol. 2015;36(5):590-3. http://www.ncbi.nlm.nih.gov/pubmed/25661968 Accessed June 16, 2015

POPULAR ARTICLES

0 10198
In May 2015, a molecular microbiology study was published in the Proceedings of the National Academy of Sciences (1). This study showed that gut...
Original illustration for Healthcare-Arena by Fran Orford