Intended for healthcare professionals

Rapid response to:


Zanamivir, influenza, and meningococcal disease

BMJ 2000; 320 doi: (Published 05 February 2000) Cite this as: BMJ 2000;320:378

Rapid Response:

Influenza and meningitis

Our recent observations concur with those of Stephen Green in his
recent letter (1).

We admitted a young Asian male on New Year's Eve with a
short history of influenza-like symptoms, depressed level of consciousness
and a rapidly evolving petechial rash. He was commenced empirically on
appropriate antibiotics immediately on arrival and was well enough to
undergo lumbar puncture the following day, which confirmed Neisseria
meningitidis microscopically. Interestingly his chest radiograph was
abnormal on admission, demonstrating a widespread infiltrate. This
remained abnormal for twenty days despite an extended course of
antibiotics (14 days). The course of his illness was complicated by
pericarditis on day 2, a lymphocytic pleural effusion, prolonged fever
with persisting acute phase
response and para-aortic lymphadenopathy. He was an in-patient for
fourteen days (of which the majority was spent in respiratory isolation),
and would have been detained for longer had he not taken his discharge
medical advice. His convalescent influenza A titres were elevated,
confirming a coincident influenza infection.

This case illustrates that an
influenza epidemic impacts on overstretched hospitals both directly
through additional acute admissions and indirectly because of the effect
on the
presentation and manifestations of other infectious disease processes. The
new range of anti-viral agents we now have in our armoury has the
potential to act as the 'finger in the dyke' and reduce both the
predictable caseload and the unforeseen financial burden of influenza

1. Green ST. Zanamivir may help to fight potential flu epidemic.
BMJ 2000;320:378 (letter 5 February).

Ben G. Marshall

Khulud Al-Majali

Specialist Registrars

Gill Whitfield
Senior House Officer

Philip W. Ind
Claire Shovlin
Consultant Physicians in Respiratory
and General Internal Medicine.

Hammersmith Hospitals NHS Trust, London W12

Editorial note
The patient has given his written informed consent to publication of his case.

Competing interests: No competing interests

17 March 2000
Ben G Marshall