pdf Subject: Reported death from Meningococcemia at The Medical City last Dec. 9, 2006 ______________________________________________________________________ Introduction: On December 10, 2006, the Regional Epidemiological and Surveillance Unit (RESU) was informed by Mrs. Vicky Ching, Infection Control Nurse of Medical City, of a patient who died of Meningococcemia several hours after admission at The Medical City Hospital. Coordination with Dr. Rolando Paac, City Health Officer of Taguig City, Dr. Jun Palma and Ms. Daisy Bulacan, surveillance officers of the City Epidemiological and Surveillance Unit (CESU), Dr. Alzona, Rural Health Physician in Napindan, Mr. Victor Ong, owner of Paulinian Pawnshops and Mr. Mario Esguerra, Barangay Captain of Napindan was done. Methods: The RESU interviewed the husband and other members of the family of the deceased. Review of medical records at The Medical City and contact tracing were conducted. Review of Meningococcemia cases and deaths in Napindan, Taguig during the past year was also done. A Suspect Meningococcemia case is one who developed sudden onset of fever >38C with at least one of the following: neck stiffness, altered consciousness, bulging fontanelles in infants and non-blanching purpuric or petecchial rashes. A Clinically confirmed Meningococcemia case is a suspect case with acute fever, in shock and with rapidly progressing rash with no laboratory diagnosis done or questionable laboratory result. A Laboratory-confirmed Meningococcemia case is one who obtained positive result from one of the following tests: isolation of N. meningitides from a sterile site, blood or CSF; identification of N. meningitides DNA from the sterile site, blood or CSF; and positive latex agglutination for N. meningitidis in the CSF. Findings: CL was 39 years old, Female, Married, childless and a resident of 7 D. Labo

The following morning.85) and presence of toxic granues. she had fever. she was noted to be lethargic and disoriented. A few hours before death. meningitides. looking very weak. dried lips and tongue. Patient was a known asthmatic. throat pain. Culture of the blood sample revealed growth of N. 9. two days after her death because the relatives refused early burial due to financial constraints. she was still febrile. On physical examination. elevated creatinine level. Taguig. 11 (12:00 PM). low sodium level. She was connected with three Paulinian Pawnshops located at Rosario and San Joaquin. The relatives thought she had dengue fever and so they decided to bring her to the hospital. Conjunctival suffusion. cough and colds. Pasig and Antipolo and Neutrophils (0. The corpse was buried on Dec. She had no history of trauma involving the head or any part of the body. Admitting diagnosis was Meningococcemia. Patient thought she had influenza. Significant laboratory results were: elevated WBC count (23. restless and disoriented. A few hours before she was brought to The Medical City. Final Diagnosis was Meningococcemia with Meningococcal Meningitis. with Meningococcal Meningitis Patient was given IVF and parenteral antibiotics. Last December 7. nuchal rigidity and generalized petechial and purpuric rashes were noted. No medication was taken. Last year s surveillance data revealed no reported case or death from Meningococcemia . However. The Medical City. headache and vomiting (about ten times). Appearance of multiple erythematous macules and patches were noted on the arm and shoulder.000/ cu. She had her last attack of asthma last Nov. Napindan. Patient expired at about 2:26 PM of Dec. patient was tachycardic (138/min) and hypotensive (70/ 50)..2006. she came home from work with complaints of severe headache. 2006. the Taguig City Health Office facilitated immediate burial of the corpse at a Catholic Cemetery.St.

In endemic countries. Patient developed shock early and then expired on the second day of the illness. meningitides) which was done at The Medical City. Chemoprophylaxis was given to fourteen close contacts. Seven co-employees (including the employer) in the three pawnshops where she worked and the four staffs of De Guzman Funeraria were also given chemoprophylaxis. The organisms do not survive well outside the human host. Chemoprophylaxis against meningococcemia is very crucial since this will prevent the occurrence of the disease among the contacts as well as eliminate the carrier state. gram-negative diplococci that colonizes the oropharynx and nasopharynx of asymptomatic carriers. All the identified contacts will be monitored for two weeks for any development of signs and symptoms of meningococcemia. Case Fatality Rate (CFR) is 5-15% for those diagnosed and treated early. CFR exceeds 50% with late treatment. On the other hand. The causative agent is Neisseria meningitidis. Transmission is thru direct contact with contaminated respiratory secretions or inhalation of infected droplets from a known infected case or close direct physical contact with an infected carrier. Discussion: CL is a Laboratory-confirmed case of Meningococcemia. Meningococcemia is the leading cause of meningitis and rapidly fatal sepsis in otherwise healthy individuals. The source of the infection was undetermined since she had no exposure to a known meningococcemia case. Incubation period is from 2 10 . Rapid deterioration of the patient s condition was very evident. CFR for meningococcemia without meningitis is 25% more as compared to meningococcal meningitis. Confirmation was based on the result of the blood culture (growth of N.ten family members of CL and four neighbors who assisted her during transport to the hospital. 5-10% of the population is asymptomatic Napindan. Taguig. She could have gotten the infection from a carrier.

commonly 3-4 days. meningitis and pneumonia. 6. Taguig City 2. septicemia. Distribution of health advisories on Meningococcemia Written by: DR. Clinical features are sudden onset of fever. Strengthening of Meningococcemia surveillance in Napindan. ecchymoses. stiff neck. It can progress to invasive disease such as bacteremia. intense headache. nausea and vomiting. Coordination with the RHU of Napindan regarding setting up of Meningo-surveillance 3. Chemoprophylaxis of medical staffs who had direct contact with the deceased Taguig City Health Office: 1. Coordination with Mr. Immediate burial of corpse at a Catholic Cemetery in Taguig By the CHD MM RESU: 1. Coordination with Ms. coma and death. ANTHONY Z. Chemoprophylaxis of family contacts (10) with Ciprobay 2. Raquel Havana. Surveillance Officer of Pasig City Epidemiological and Surveillance Unit for setting-up of Meningo-surveillance in the two areas where the two pawnshops are located. Dante de Guzman for chemoprophylaxis of embalmers of the deceased 5. 4. employer of Paulinian Pawnshop. petecchial rash with pink macules. Actions Taken by: The Medical City: 1. Victor Ong. shock. for chemoprophylaxis of other contacts in the three pawnshops. Information education on Meningococcemia 4. SAN JUAN Epidemiologist . Coordination with Mr.days. delirium. Chemoprophylaxis of other close contacts in the community 3.

the patient worked with only one known N. No mishap had been reported at the hospital laboratory where the patient worked. CDC performed isoenzyme testing on the laboratory worker's nasopharyngeal isolate. . During the next 24 hours. Serum was positive by a bivalent (groups C and W135) latex agglutination test for N. During the previous 3 months." Blood cultures and cerebrospinal fluid studies were negative. the workplace isolate.01. On March 8.http://findarticles. A throat culture grew N. skin lesions. trunk. nor could the patient's co-workers recall any episode no additional information regarding a mishap could be discovered. laboratoryacquired infection is rare (1). arthralgias. Both the workplace isolate and the laboratory worker's nasopharyngeal isolate were identified as N. Case 1. diarrhea. and confusion. Fisher's exact test) and from a collection of 256 group C meningococci isolated between 1986 and 1989 (p 0. They differed from the 14 northern California isolates (p 0. a clinical laboratory bacteriologist in California became ill with influenza-like symptoms and nausea. meningitidis. she developed fever. meningitidis isolate. and 14 other unrelated but recently isolated group C strains from throughout northern California. myalgias. meningitidis. and extremities she died 6 hours later. which was obtained from the blood of a patient with acute meningitis and cultured by the affected laboratory worker 5-6 days before onset of her symptoms. meningitidis serogroup C by the Microbial Diseases Laboratory of the California Department of Health Services. The isoenzyme type of the laboratory worker's isolate and the workplace isolate were identical and rare. consistent with acute meningococcemia. The final autopsy diagnosis was "clinical acute intractable shock. Her husband informed ambulance personnel that she had had a mishap in the laboratory approximately 1 week earlier with a type of organism that causes meningitis. on March 9. This report describes two fatal cases of meningococcal infection in laboratory workers both of these cases probably were laboratory acquired. 1988. Fisher's exact test).California and Massachusetts Although Neisseria meningitidis is commonly isolated in clinical laboratories. When hospitalized at 10 p. she was hypotensive with numerous petechial and purpuric lesions on her face. Laboratory-Acquired Meningococcemia -.m.

. She had been observed using gloves to subculture an N. 1988. the workplace isolate. On the morning of September 6. Three previous case reports describe infections in persons working in research laboratories who handled meningococcal organisms frequently and in large volumes (1. Twelve hours later. meningitidis was never isolated from the blood of the laboratory worker in California.02. Isoenzyme testing performed by CDC on the patient's blood isolate. she died 6 1/2 hours later. These cases represent the first reports of meningococcal infection acquired in the clinical laboratory setting. Although laboratory workers frequently handle specimens and cultures containing meningococci. Blood cultures grew N.Case 2.m. sore throat. Fisher's exact test). she presented to the emergency room semiresponsive. and nine other unrelated but recently isolated group B strains from Massachusetts demonstrated that the isoenzyme pattern of the patient and workplace isolate were identical. meningitidis during the 3 weeks before the patient's illness. She was sent home at 1 p. and she had extensive rhinorrhea. meningitidis group B. dyspneic. The laboratory had not isolated N. and myalgias. Although N. hypotensive. Both the workplace isolate and the patient's blood culture isolate were identified as N. On September 3 and 4. and with petechial and purpuric skin lesions. Despite antibiotic therapy. They differed from the nine other Massachusetts group B isolates (p 0. a microbiology technician at a teaching hospital in Massachusetts presented to the hospital's employee health clinic with a history of several days of rhinorrhea. meningitidis isolate. A gram stain of the buffy coat of her blood showed gram negative diplococci. The worker in Massachusetts may have been at increased risk for meningococcal infection several studies suggest that concurrent viral infection increases the risk of developing invasive meningococcal infection [3-5!. other evidence supports the conclusion that she had laboratory-acquired meningococcal infection. the patient worked in the bacteriology laboratory of another hospital. meningitidis is rare. with a diagnosis of viral syndrome. the laboratory workers probably are not at increased risk of infection when standard microbiologic practices are followed.2) two of these occurred before the availability of effective vaccines and antibiotic therapy. meningitidis serogroup B. For several days before her hospitalization the patient had been working in the bacteriology laboratory at the teaching hospital despite her upper respiratory infection symptoms. Editorial Note: Laboratory-acquired infection with N.

ph/books?id=cgJRTdOcuB8C&pg=PA134&lpg=PA134&dq=meningococcemia+c ase+study&source=bl&ots=rp9yfEeBl&sig=vd9Mvini7WyF1ByaPWpVrehyq8A&hl=tl&ei=x7wNTbbGEoj5cai7NwK&sa=X&oi=book_result&ct=result&resnum=3&ved=0CCYQ6AEwAjgU#v=onepage&q=meningococ cemia%20case%20study&f=false A 10-year-old boy presents with meningococcemia. and 1 and fibrin degradation products. (3) marked anion gap metabolic acidosis. His vital signs are as follows: temperature. 12 monocytes. That . and (5) blood urea nitrogen and creatinine. partial thromboplastin time. 2700/mm3 with 25 segmented neutrophils. His capillary refill time is 4 to 5 seconds. 103 F.000/uL. Which one is the number one priority? Acute Pain FVD High Risk for Injury Risk for Ineffective Cerebral Tissue Perfusion KD Risk for Trauma/Suffocation Hyperthermia Risk for Infection (1) FVD (2) Hyperthermia (3) Acute Pain (4)Risk 4 ineffective cerebral tissue perfusion (5) High risk 4 injury (6) Risk for Trauma/Suffocation (7) Risk 4 infection (8) KD Is this right? No. the patient is lethargic but arousable. and platelet count. 40 breathes/min with obvious hyperpnea. and a rapidly progressive petechial http://allnurses. increasing lethargy. 20 lymphocytes. 140 beats/min. He has had no urine output in 12 hours. 10 g/dL.Opisthotonus Brudzinski Kernig s http://books. hematocrit. blood pressure 70/30 mm Hg. Laboratory data include the following: (1) complete blood count. all elevated. Some are labels not even approved by NANDA. heart rate. with hemoglobin. On physical examination.html Lets say a patient has Bacterial Meningitis and these were some diagnoses. 40 bands. elevated. (4) liver enzymes elevated (80Os). 2 eosinophils. Many of them are not the current NANDA labels. I have sequenced them and given you my reasons below. 30%. He has a 24-hour history of fever. 43. His skin examination reveals a diffuse petechial rash that is becoming purpuric in the groin region. (2) prothrombin white blood cell count. and respiratory rate.

Deficient Fluid Volume (physiological need for fluid) Hyperthermia (physiological need for control of body temperature) Acute Pain (physiological need for comfort) Deficient Knowledge (safety need) Risk for Ineffective Cerebral Tissue Perfusion (anticipated need for oxygen to the brain) 6. very vague (trauma) and.pdf 1. I would never compose a diagnosis like ray and CT scan) they resulted in nothing but she was treated with ATB and also IV fluids all pushed thru a PCVC.RR 18 POX 96% is denies any pain even though when she was admitted she complained of HA and I have to assess her on her 6th day of admission so obviously she was much improved so I am just feeding out of information I got from the Dr's note. 4.makes it difficult to determine priority. 3. 2. http://allnurses. High Risk for Injury (anticipated need for protection) 1. on one Risk for Infection (anticipated need for physiological safety) 8. 5.prenhall.p 88. 4. Risk for Trauma/Suffocation (anticipated need for oxygen to the lungs-trumps the anticipated need for protection) 7. very specific (suffocation--involving breathing and oxygen). 2. Deficient Fluid Volume (physiological need for fluid) Hyperthermia (physiological need for control of body temperature) Acute Pain Fear/ Anxiety .she is alert & orientedX2 earlier on but was improved by day I don't really have much to go with since my patients condition is improved and she was discharged after her completion of her ATB.html Well this patient came in just when she was feeling much better but her admitting diagnosis was fever and altered mental status after labs and diagnostics test(lumber puncture.Hope this helps http://wps. 3.Her vitals her bp 146/86. especially with Risk for Trauma/Suffocation which is. on the other.

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