Andrew Riordan @ MRF Childhood Amputee Day - Pushing the Boundaries

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After effects of bacterial meningitis and septicaemia: How and why?

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  • Degree of amputation, function, and quality of life for each participant (patients 1–9). Participants' results are ordered according limb loss degree (body maps). Functional ability was measured with the AMPS.6 The AMPS assesses the quality of performance of activities of daily living. Participants choose and perform 2 everyday tasks; results are adjusted for the difficulty of the task. Blue bars show motor scores (participants' ability to move themselves and the task objects). Purple bars show process or cognitive scores (how participants organize, sequence, and adapt to problems during the tasks). Quality of life was measured with Short Form-36 (>16 years of age) or the Child Health Questionnaire.7 Green bars show physical scores and blue bars mental/psychosocial summary scores. AMPS and Short Form-36/Child Health Questionnaire results are presented as z scores (number of SDs from the mean for age and gender).
  • Andrew Riordan @ MRF Childhood Amputee Day - Pushing the Boundaries

    1. 1. After effects of bacterialmeningitis and septicaemia:How and why?Dr Andrew Riordan
    2. 2. Meningococcal diseaseMeningitis• Infection of thecovering of the brainSepticaemia• “Blood Poisoning”
    3. 3. Confusion between meningitis andmeningococcal diseaseMeningococcalDiseaseMeningitisMeningococcalmeningitissepticaemiaPneumococcusHibGrp B Strep
    4. 4. Presentations of MCDRLCHs 1977-2009 (n=1157)No. DeathsMeningococcalMeningitis (MM)185 4 (2%)MM+MS 621 32 (5%)MeningococcalSepticaemia(MS)349 27 (8%)PLoS ONE 6(10): e25957
    5. 5. Normal blood flowRed Blood CellWhite Blood CellPlatelet
    6. 6. Blood flow in diseaseRed Blood CellWhite Blood CellPlateletMeningococcusEndotoxinCytokines
    7. 7. Blood flow in SepticaemiaRed Blood CellWhite Blood CellPlatelet
    8. 8. Consequences of Septicaemia• Blood that doesn’t clot in a test tube (DIC)• Fluid leaking out of blood vessels (shock)• Clots happening in blood vessels (thrombosis)• Not enough oxygen getting to tissues
    9. 9. Blood flow in MeningitisBrainCerebrospinalfluidSkull
    10. 10. Consequences of Meningitis• White blood cells and bacteria in thecerebrospinal fluid (CSF)• Fluid leaking out of blood vessels (brainswelling)• Decreased blood flow to brain• Not enough oxygen getting to brain
    11. 11. After effects of meningococcal diseaseMeningococcalMeningitis• Deafness (6.4%)• Learning difficulties(2.1%)• Seizures (1.4%)MeningococcalSepticaemia• Skin loss (5%)• Amputation (3-8%)• Deafness• Learning difficulties
    12. 12. Neurodevelopmental outcomeArch Dis Child 2001;85:6-11• 115 survivors from 1988-1990 cohort, assessed 1998-9with 115 sex and age matched controls• Cerebral Palsy 1, significant hearing loss 5• Most survivors do not have gross neurologicaldeficits.• Significant detriments of motor function, cognitiveability and behavior were found in meningococcalsurvivors.
    13. 13. Mortality in severe meningococcal disease.Arch Dis Child 2001;85:382-5.Centre Year TotalNo.PredictedmortalityActualmortalitySMRKentucky,USA1979–84 62 9.1 9 1.00Melbourne,Australia1985–92 35 14.4 12 0.83London, UK 1994-96 98 23 18 0.78Utrecht,Netherlands1988–93 53 15.4 10 0.65Merseyside,UK1995–98 123 24.9 11 0.44
    14. 14. Critical Illness and Amputation inMeningococcal Septicaemia:Is Life Worth Saving?• Young people admitted to PICU withmeningococcal disease• Nine participants who had undergoneamputations• Standardized assessments made• Funded by MRFPediatrics 2008;122:629-632
    15. 15. Degree of amputation, function, and quality of life for each participant (patients 1–9).Allport T et al. Pediatrics 2008;122:629-632©2008 by American Academy of Pediatrics
    16. 16. Quality of life after amputation.Allport et al• “Generally good”• Not predicted bydegree of amputation• Less good if learningdifficultiesPediatrics 2008;122:629-632
    17. 17. After effects of meningococcal diseaseMeningococcalMeningitisInfection of the coveringof the brain can lead to;•Deafness•Learning difficulties•SeizuresMeningococcalSepticaemiaInfection in thebloodstream can lead to;•Skin loss•Amputation•Deafness•Learning difficulties
    18. 18. Anyquestions?

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