Wesley Teoh |
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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