Monday, 29 May 2017

Monash medical student’s research highlights unusual presentations of meningococcal disease

Wesley Teoh
Improved diagnosis and increased awareness of meningococcal disease is the focus of latest research at Monash University.
School of Clinical Sciences at Monash Health final year medical student Wesley Teoh undertook an interesting case study that highlights some atypical presentations of meningococcal disease and the importance of accurate diagnosis.
Published in the Journal of Clinical and Experimental Ophthalmology, Wesley also presented his research at the 1st Australasian Diagnostic Error in Medicine Conference in Melbourne this month.
In his case study, Wesley examined a 19 year old, fit and healthy male who presented from home to the Cabrini Emergency Department with what appeared to be viral conjunctivitis. The patient’s right eye was painful, red and watery.
“The symptoms developed fairly acutely—approximately 6 hours before he presented to the ED,” said Wesley.

“Assuming it was viral conjunctivitis, the emergency physician discharged him on lubricating eye drops, however, due to the severity and acuity of his symptoms, the physician sent off a swab of his right eye for cultures.” 

Wesley said that this is where the case became interesting, as the patient’s swab came back positive for meningococcal disease.

An extremely rare condition that is usually only seen in either young children or the elderly (due to the weakening of the immune system), meningococcal conjunctivitis can potentially lead to blindness, septicaemia and even death.

Since 2014, Victoria has experienced an increase in meningococcal disease and currently there is an outbreak of the Meningococcal W (MenW) strain, which was coincidentally the same strain Wesley’s patient case study grew on culture.

“The patient was recalled back to the hospital, admitted and put on intravenous and topical antibiotics. He was discharged after two days, following normal investigation results and ophthalmology review,” Wesley said. 

Wesley explained there are some interesting points worth highlighting in this case study.
“Firstly, the most common presentation of MenW is still septicaemia, however, MenW is also notorious for presenting atypically.”

“There are cases of septic arthritis, epiglottitis and pneumonia; the question is can conjunctivitis also be one of its ‘new’ atypical presentations?” Wesley said.

“Secondly, meningococcal disease usually affects people who live in crowded conditions (for example, those living in a dorm or a share house. But our patient lives at home with his family and is a fit and healthy cyclist.”

According to Wesley, the take home messages from this study are:
·         Be aware of the increase in meningococcal disease (especially MenW) in Victoria.
·         Be aware of MenW's atypical presentations - septic arthritis, epiglottitis, pneumonia and now conjunctivitis.
·         If a presumably benign condition (like viral conjunctivitis) looks unusual, investigate.
·         Meningococcal conjunctivitis is not benign and can cause blindness or even death.
·         Meningococcal conjunctivitis needs to be treated with both topical and intravenous antibiotics.
·         With the rising incidience of meningoccocus, vaccination is key to prevention!

Wesley acknowledges and thanks the patient and his family for allowing him to study his ‘interesting case’, as well as the doctors at Cabrini Hospital, including Dr Katherine Walker, Dr Antony Bottrall, Dr Eugene Teh, Dr Richard Stawell and Jenny Couper.

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