Published 25 August 2009, doi:10.1136/bmj.b3423
Cite this as: BMJ 2009;339:b3423

Letters

A/H1N1 pandemic

Misdiagnosis in the time of meningitis

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

Distinguishing viral illness from serious bacterial infection is notoriously difficult. Many of the symptoms currently recommended as "screening" questions for A/H1N1 flu such as fever, coryza, sore throat, headache, muscle aches, vomiting, and diarrhoea may also be present in early stage meningococcal disease.^{1 2 3} Whether these symptoms represent a preceding viral illness or are a prodrome of infection with Neisseria meningitidis is unclear. The Scottish Intercollegiate Guidelines Network (SIGN) recommends that meningococcal disease cannot be excluded in children with non-specific signs and symptoms presenting within the first few hours of their illness.⁴

A review of evidence for electronic decision support systems suggests that even those operated by clinicians lack sensitivity and specificity.⁵ As we enter the peak season for both flu and meningococcal disease, even experienced practitioners who rely on telephone triage to diagnose A/H1N1 flu in children without a full clinical assessment are at risk of missing serious bacterial infection . . . [Full text of this article]

¹ Royal Belfast Hospital for Sick Children, Belfast BT12 6BE, ² Queen’s University Belfast, Institute of Clinical Science, Belfast BT12 6BJ

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