When is Meningitis not Meningitis?

[-Ralph-]

The wee lad gave us and the doctors a wee scare today with a high temperature, vomiting, severe headache and a rash on his forearm that didn't disappear when rolled with a glass.

So his first ride in an ambulance and doctors didn't want to delay the ten minutes it would have took to wait for an anesthetic cream to work, so they freeze sprayed the back of his hand and stuck in a drip, queue much screaming from Euan. There was a fair bit of blood and it must have been painful poor boy.

So they took blood samples and the results came back about an hour ago, negative for Meningitis (Phew!). He perked up a lot in the last couple of hours, and seems quite well, temperature down, says the head is getting better, and hasn't vomited since about 8pm, but he still has this rash like he's been pr1cked with a load of needles. The doctors agree is is spots of blood coming to the surface under the skin, but haven't come to any conclusion as to what it is.

So I just got home and he and Mum are spending the night in the childrens ward.

Now, I'm not looking for medical advice on a biking forum :rolleyes:, but there are a few doctors and nurses and a lot of parents on here.

What have you seen in the past that it could be?

[thulfi]

I'm revising for my medical finals at the moments so a rarity of actually being clued up.

Firstly, I'm sure it's all been a bit distressing and I hope the little fella makes a quick recovery. A rash that doesn't disappear with glass is known as a non-blanching rash. The good news is that only 10% of these are attributable to meningitis or other infections, with the vast majority being benign and self limiting. It is of course important to rule out the former due to complications that can arise from delayed treatment.

Google 'non blanching rash in children' and you'll have a fair bit of information at your disposal.

I find it odd though that you mentioned the bloods came back and they had excluded meningitis. The absolute gold standard and most accurate diagnostic method for meningitis is a lumbar puncture, where cerebrospinal fluid (spinal fluid taken from the lumbar region with a needle) is analysed. Sometimes there may be certain reasons why they may delay doing a lumbar puncture, but are you certain that they have excluded the diagnosis based on the bloods alone?

Like I said though, rest assured that the vast majority of these presentations are not sinister. Nontheless, the diagnosis can sometimes be missed which is the last thing anyone wants, so always better to treat these things with more caution. It may be worth asking the senior doctors tomorrow about the lumbar puncture. They may have put if off for a reason, but I will be surprised if they don't eventually end up doing one. Sooner is much better than later.

Hope it all works out and that the little one is out in no time. We adults hate hospitals and children hate them even more!

[-Ralph-]

Google 'non blanching rash in children' and you'll have a fair bit of information at your disposal.

I find it odd though that you mentioned the bloods came back and they had excluded meningitis. The absolute gold standard and most accurate diagnostic method for meningitis is a lumbar puncture, where cerebrospinal fluid (spinal fluid taken from the lumbar region with a needle) is analysed. Sometimes there may be certain reasons why they may delay doing a lumbar puncture, but are you certain that they have excluded the diagnosis based on the bloods alone?


I questioned it directly "so no sign of meningitis in the bloods?", the reply was "the bloods look fine, no infections are showing up at all". She did seem a little cagey about it though.

However, there are three children in the childrens ward tonight with similar symptoms (chatting with parents in the tea/coffee area), one was a 3 1/2 month old baby who has had a lumbar puncture and spinal fluids taken.

[-Ralph-]

Note that he had perked up a lot and was starting to look and behave normal again in the last 90 minutes before he settled down for the night in the childrens ward and I left the hospital, the rash wasn't spreading any further. The A&E doctor said he more comfortable on seeing him chatting and playing again that we weren't dealing with meningitis, but said until blood results were back, they couldn't rule it out.

[-Ralph-]

Google 'non blanching rash in children' and you'll have a fair bit of information at your disposal.

Thanks for that. Done some googling, and the rash he has is definitely "Petechiae", pin-head sized red dots.

[Milky Bar Kid]

I can't help on this one but I hope the wee man is feeling better soon. Poor wee falla!

[Specialone]

Col, thats really crap for the little dude, how fecking scary for you and Sandrine.

An old neighbours daughter in the 80's contracted meningitis and died so quickly because they didn't get treatment quickly enough, you done the right thing by getting him to A&E asap, also they are more switched on about this illness now and a lot more reactive.

Hope he gets better asap, times like this I'm glad I'm not a parent, dunno how id cope with this stuff.

[Stenno]

I'm not sure our speculation will be of any help so I'll just say I'm glad the little one has perked up and hope you and Mrs Ralph are feeling a bit more at ease :)

[maviczap]

There's some nasty bugs going round at the mo, and the rash you describe is simialar to what my youngest had over half term

She was sick and high temperatures every day before the calpol took effect, 38.9 deg

Rang the surgery who gave advice, but calpol managed the situation, although it lasted 5 days in all, which wasn't nice for her. The rash appeared on the last but one day she was ill.

The last day she perked up and was running around as normal, she went up stairs and fainted!

Luckily she fell into the laundry basket, so a soft landing, but my eldest daughters screams weren't good for my ticker.

Took her to the doc and got the all clear, poor little mite had run out of fuel, so spent the rest of the holiday eating.

The school sent out a letter the first week back at school, saying there had been some cases of 'slapped cheek' which is some form of virus.

So I hope your lad is better now, mine still looks a bit pale, but is back to her good sleeping pattern

[dizzyblonde]

When I was a kid, I had 'Meningitis that wasn't meningitis' one xmas. Apparently the family spent xmas with the curtains closed, as I was so desperately ill I couldn't bare light, threw up everywhere and had the usual symptoms!
These were the days when you probably didn't rush off to the hospital, as the rash with the glass thing wasn't pushed as a sign to look for. I was taken to the doctor when the surgery was open, and the doctor said 'yup she probably had meningitis!'

NICE :(
Sounds like MiniRalph is getting better :), poor fella!

[Speedy Claire]

What a worry for you both! I have to agree with Thulfi tho and express surprise that they haven`t done a lumbar puncture as this is, and as far as I`m aware things haven`t changed, the diagnositic test of choice when dealing with potential meningitis. The medics must be extremely confident that they`re not dealing with meningitis but I`d make a point of questionning why they haven`t carried out this test.

I had a similar scare with my son at a young age and it turned out to be a nasty virus that caused symptoms similar to meningitis but also caused swelling in his joints but there`s a few things this could turn out to be and I wouldn`t and couldn`t try to diagnose it.

Is good to hear that he`s on the mend and I hope he recovers quickly and is soon back home x

[Dave20046]

poor guy! nothing useful to say other than get well soon!

[G]

Lumbar puncture... The most painful thing I have ever had done EVER :(

[Jordy]

A spinal injection does sound painful! I hope he makes a full recovery soon.

[dizzyblonde]

Lumbar puncture... The most painful thing I have ever had done EVER :(
Is it anything like having an epidural thingy? Had one o those with the caesarian......I agree the most horrid scary thing EVER!! Get lost coming near my back with a sharp pointy stick:pale: Not somethin to put a poorly little person through!

[kellyjo]

Lumbar punctures??? I've had 8 of the buggers, but they've all been carried out by competent bods and though uncomfortable with all the pushing in my back they've not been painful. The pain comes after when theyve drained away my cerebral spinal fluid and my eyes and brain want to implode :-( Just had a lumbar-pleural shunt fitted though so hopefully no more LP's, yay!!!

Back on track though - glad the little man's recovering Ralph, sick kids are sooo scary. Had my eldest son down A&E with 'THE' rash when he was a toddler, but it wasnt meningitis and we never did fnd out what it was!.

Important thing is that the medics reacted quickly and your little chap is recovering now :-)

[-Ralph-]

Thanks for all the well wishes folks.

Indeed it is scary. When the doctors told me they couldn't wait 10 minutes for an anesthetic to work before taking blood, and I didn't realise it at the time, but then the doctor wouldn't tell me much about the blood test results late last night, both have made me **** myself if I'm quite honest. When the professionals were clearly getting worried, that made me 10 times more worried.

Anyway, he is home now, and other than the rash he is absolutely fine. The doctors haven't fully discharged him, just allowed him to come home, and told us to keep an eye on the rash and if anything changes we can go straight back to the childrens ward without having to go through the process with A&E again.

Thulfi, you were right, they hadn't ruled out meningitis and still haven't, but they have ruled out the nasty kind that gets all the headlines, but the pediatrician said today there are other forms of menigitis that can come and go, not be here today, but re-appear tomorrow. The trouble is every time you speak to a doctor it's a different opinion and a different approach to how much they want to tell/explain to you. The pediatrician decided not to put him though a lumbar puncture as all the symptoms other than the rash were clearing up and overnight he did not look like a child with meningitis to him. He has diagnosed a viral infection which is impairing his blood clotting ability.

[thulfi]

That's good news mate. The improvement in his clinical signs is very promising, and they've ruled out the nasty meningitis (meningococcal) which is always the main concern in these instances.

You seem to be in good hands, and paediatricians sure do know their stuff. You're always bound to get slightly different opinions and approaches as you talk to various doctors, but the consultants are the big dogs and usually have the final say in any management, usually after discussing the case with the other seniors and members in the team during their ward rounds or multi disciplinary meetings.

Hope the little one recovers fully soon and stays hospital free.

[davepreston]

obviously hope he's better soon, and you two dont get too stressed
as for when is meningitis not meningitis, allergy to peniccilen, this happened to me ,i turnrd into a mr blobby look alike, got quarintined and filled with ,you guessed it more penicillian, a week later they worked it out after some very painfull tests but its one to run passed the doctor when you speak next ,especially as it may present like a infection
hth
dave

[-Ralph-]

obviously hope he's better soon, and you two dont get too stressed
as for when is meningitis not meningitis, allergy to peniccilen, this happened to me ,i turnrd into a mr blobby look alike, got quarintined and filled with ,you guessed it more penicillian, a week later they worked it out after some very painfull tests but its one to run passed the doctor when you speak next ,especially as it may present like a infection
hth
dave

Thanks Dave, he hasn't been on any penicillin, but I read on the internet* that one of the causes of Petechiae is allergy to a drug he has taken. He started on Cetirizine Hydrochoride last Monday to try and tackle swelling and weeping eyes that we believe to be down to hayfever (fields here are yellow as far as the eye can see with oil seed rape, the air smells floral). If it is an allergy to Cetirizine, not a virus though, it will go through a repeat performance at some point this week or next.

Just 'cos he's home and seems better, lets not kill this thread, as with Dave's post, I'd still be really interested in anyone else who's dealt with the same at work, or with their kids. Thanks.

[fizzwheel]

Not my kid, and I dont know how relevant it is. But..

Girl at work, her little boy had a rash, she did the thing with the pint glass and took hiim to A & E as she was worried it was meningitis, Dr at A & E said no, he has chicken pox and sent him home. 3 days later he was getting worse took him back as he started having a fit, turned out it was meningitis and the chicken pox had masked the symptoms.

Her little boy was poorly for along time and its put his development back and he's had an awful lot of catching up to do, but is almost fully recovered and caught up again now.

-Ralph- glad your little one seems to be on the mend.

[-Ralph-]

*Internet = friend or foe in these instances???

Googling as Thulfi suggested last night (I couldn't sleep anyway) helped me a lot to understand what was going on, but these websites can make you hypochondriac / paranoid as well. I came across one site which does a "diagnosis" by process of elimination.

So you start with the main symptom Petechiae, it gives you a list of possible causes

Then you add the next symptom, Fever, it narrows down that list of causes

Then you add the next symptom, Vomiting, it narrows down that list of causes further

Then you add the next symptom, Headache, it leave only one possible cause = Leukemia!

WTF???? Leukemia? He'd better not have Leukemia! Off to google Leukemia and find it is usually diagnosed by a simple white blood cell count, which had already been done. Tell you what I could have punched whichever rrrsshole wrote a piece of software saying that was the only possible cause and stuck it on the internet for every parent to find!

[Amplimator]

Glad the lil fella is getting better chap. These days things have advanced so much and it can be caught early enough.

I had meningitis when i was three. I died/was resus a coupla times. Had the lumbar puncture too, back then wasnt too great (twas 1978). I was strapped to the bed and mum and dad could hear me screaming as they went down in the lift. Left me with nerve damage, i was unable to support my own head and mum had to carry me everywhere as i couldnt walk/talk or do anything but dribble really. I was essentially a cabbage. (i still am a bit :p )

Somehow, i recovered. I was according to docs a miracle, started school late but soon caught up and overtook other kids my age. Though it left me deaf, i was lucky to keep my speech due to being a 'chatty lil chap' before i got ill so still had the basics. Thankfully i dont remember much 'cept my plastic room.

I still feel very fortunate, because i can switch my aid off when the missus has a moan ;)

[thulfi]

There is a lot of crud out there on the interent. As a rule of thumb, avoid websites that are not UK based or clearly unreliable like wikipedia etc.

A diagnosis by process of elmination on a website is ridiculous, and very few medical conditions can be diagnosed in that way (apart from very rare uniqe syndromes). Certainly not the general common symptoms you are describing. Medical history, examination and investigations are crucial in working up a diagnosis, and it's not as simple as typing a load of symptoms into a 'diagnostic calculator'. Petechiae, fever, vomiting and headache doesn't leave the one possible cause of leukaemia and in fact that would be one of the less likely diagnoses, but an important one to exclude (though easily done as youve mentioned by looking at the white cell count).

A very good website that I would recommend is patient.co.uk. There is information there for patients and more detailed sections for the doctors that you can also read. It's always easy to look at a long list of possibilities for condtions that fit certain signs, and it's human nature to worry about the worst one. You'll find doctors are the worst at this, and always think of the worst possible scenario when a family member or themselves have come down with something.

Reading long lists of possible conditions may not be too reassuring, but any good medical website that is worth anything will aim to give the reader some reassurance in terms of epidemiology/statistics before they start listing them.

[Speedy Claire]

So glad to hear he`s home and recovering.... what a relief!!! the internet is definitely not your friend at times like this and in fact I thought to myself omg I hope he doesn`t go googling!!! Ewan is on the mend, you have your sanity badk and that`s all that matters.

[davepreston]

Thanks Dave, he hasn't been on any penicillin, but I read on the internet* that one of the causes of Petechiae is allergy to a drug he has taken. He started on Cetirizine Hydrochoride last Monday to try and tackle swelling and weeping eyes that we believe to be down to hayfever (fields here are yellow as far as the eye can see with oil seed rape, the air smells floral). If it is an allergy to Cetirizine, not a virus though, it will go through a repeat performance at some point this week or next.

Just 'cos he's home and seems better, lets not kill this thread, as with Dave's post, I'd still be really interested in anyone else who's dealt with the same at work, or with their kids. Thanks.
im glad you took my post as ment mate, this happened to me in a perticular situtation its not a diagnosis (far from it) i agree in general the internet is full of it when it comes to medical stuff, the doc's acutally test fo things and are 99.9% of the time right, your situation is completely different so "it's not properly relevent to you" but handy to know none the less

as claire says he's home ,he's well so all is gravy, take it as the way forward and life will return to normal

all the best
dave

[daveyrach]

My son had menigitis when he was a baby which unfortunatley has left him profoundly deaf and with an Autistic Spectrum disorder all because they did not diagnose it quickly enough. I dnt mean to scare thought i would just share.

[-Ralph-]

My son had menigitis when he was a baby which unfortunatley has left him profoundly deaf and with an Autistic Spectrum disorder all because they did not diagnose it quickly enough. I dnt mean to scare thought i would just share.

Sorry to hear that, that's terrible for you guys. I have to admit, I knew a non-blanching rash could mean meningitis, and I knew meningitis could be serious or fatal, but I had no idea of what else it was capable of.

[dizzyblonde]

I know my cousin caught meningitis when we were early teens. I can remember everyone being rather alarmed, as she was touch and go if she'd make it. More so for her mum, as shes been pretty high up in the nurse capacity of the NHS for years. Alarming as its exceptionally contagious, and luckily we hadn't been near their house for a week or three, so couldn't catch it, but I think loads of people at school in her class, and hung around with her, were being watched for signs of falling with it.
I know she was off school for flippin ages, not sure if it left her with anything bad, as an after effect, but it was a long time ago.
I'd forgotten about it til this morning.
I think, thankfully if it was the bad type, you'd be biting your nails in hospital. and if hes still gettting better...ALLS WELL :) 8)

[Quedos]

He;s home and feeling better which is the main thing.
Though Like Claire I hoped you wouldn't google but we have a morbid curiosity of these thing ( i still google my mums cancer and feel please when I see things changing for the better)

A friend got menigitis as a teenager and contracted septicimia through it and amputated left foot and right leg at the knee. She had a real bad time and touch and go. But she's made it through and she's wicked on a basket ball court!

As for Leukiemia - you don't want that Garrys neice was diagnosed at 17months and its been hell. You can't gauge pain in a little one and the chemo really does ravage the body. So i'm glad that it wasn't that (but get a slapp on the wrists for googling)

Hugs

[-Ralph-]

I have no regrets about googling, it helped me to understand what causes Petechaie and enables me to ask the doctor questions and give him information that I would never have thought relevant. For instance his Platelet level was written down on his paperwork incorrectly, and it wasn't noticed until I asked the Pediatrician if it was normal and he realised the figure was in completely the wrong ball park, gave a nurse a bollocking, and sent her back to the computer to have it checked against the computer and corrected. Without Google I wouldn't have known what a platelet was, and the Pediatrician obviously hadn't even looked at it until I asked the question.

I'm not daft enough to take anything I read on a website as gospel, and I certainly wasn't going to trust a website that tried to do a diagnosis by process of elimination.

The internet can be your friend, as you can understand much more than the doctor ever tells you. I have been asthmatic for 15 years, and after my last asthma attack last year I did some googling and understand my own symptoms and the medication I take for it much better than I ever have in all that time. The doctors don't have the time to go into that depth, and they don't want to because they think you won't be able to understand it anyway. I used to do exactly the same with my customers and computer systems, I wouldn't always tell them what the problem was, because they would just give me a blank face in response.

So long as you trust the doctor foremost and use the internet to fill in the gaps, it's OK.

[kitkat]

hope wee man is well on his way to recovery now. My mate sharon has had meningitus twice in last 3 years. Its the viral type (think peter andre had it when he was filming his sad life with jordan). anyway she had headache (thought it was migraine) chucking up and stiff neck. I was staying with her at the time. phoned her dad to call ambulance. they came and gave her penicillin and said it was tonsilitus. dad took her to doc in the morning and she was taken by blue light ambulance to hospital. was in for 3 days and let home. she had this again last month. There are so many strains of meningitus you only hear the horror stories and most people when they hear the word meningitus think the worst. hope you and Mrs Ralph are coping. Its horrible when your little one is ill. Libby was ill last month with scarlet fever (I thought it was middle ages disease) but after 10 days of penicillin she is fighting fit again.

[Nick762]

Not sure if anyone has posted this yet but this link is useful for anyone who has any queries

http://www.meningitis-trust.org/

Although everyone is now much more aware of the non blanching rash, bear in mind that it is a very late sign and there are others, less well known which can be lifesavers if spotted early enough.

Glad your little one is on the mend.