Clinical management of meningococcal disease

BMJ 1998;316:1015 ( 28 March )

Letters

Clinical management of meningococcal disease

Coning may occur without lumbar puncture being done

Lumbar puncture is still performed in patients with contraindications

Authors' reply

Laboratory confirmation is important

Prospective international registration of patients may be needed

Coning may occur without lumbar puncture being done

The first 150 words of the full text of this article appear below.

EDITOR $---$ Wylie et al do not give the ages of their 252 patients with meningococcal disease, but their recommendation for fewerlumbar punctures should be interpreted cautiously in children.¹Four deaths were attributed to lumbar puncture, which was donein 198 patients. Two patients deteriorated after lumbar puncture,and postmortem examination showed brainstem herniation. Even whenlumbar puncture is not performed, however, patients with meningococcaldisease can deteriorate after admission and can cone secondaryto raised intracranial pressure. A causal relation in these twocases is not proved.

In two patients antibiotic treatment was delayed because initial examination of cerebrospinal fluid was normal. This is acriticism of clinicians, not a risk of lumbar puncture. The riskof cerebrospinal fluid initially giving false negative resultsand the difficulty of diagnosing meningitis clinically in youngchildren are both recognised. If an ill child warrants a lumbarpuncture then he or she should . . . [Full text of this article]

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