Guidelines for the Early Clinical and Public Health Management of ...

Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease)
12. MANAGE COAGULOPATHY IF
PRESENT
HAEMATOLOGY CONSULTATION
REQUIRED
13. IF MENINGOCOCCAL INFECTION
SUSPECTED OBTAIN THROAT SWAB
and/or PERNASAL SWAB
14. CONSIDER FURTHER
CONSULTATION
15. CONSIDER RENAL REPLACEMENT
THERAPY
Review coagulation screening results:
• If PT and/or APPT > 2ULN (upper limit
of normal) – give Octoplas ® , 10 – 20
ml/kg
• If Fibrinogen < 1.5g/L correct with
fibrinogen concentrate (Riastap/
Haemocomplettan). It should be
given at a dose of 70 mg/kg and the
fibrinogen level rechecked 1 hour
following completion of the infusion
• Reserve platelet transfusion for those
with active bleeding or if platelet count
< 20 x 10 9 /L and severe consumptive
coagulopathy. If indicated transfuse
with 20 mls/kg of platelets for children
and 1 bag (pool) for adults
The order in which blood products and
anticoagulants are optimally used can vary
from patient to patient and may significantly
affect outcome. It is critical that guidance
from a haematologist experienced in
the management of meningococcal
coagulopathy be obtained OCTOPLAS®
is the plasma replacement used to correct
consumptive coagulopathy in bleeding
patients, as it contains a wide selection of
coagulant and anticoagulant factors.
For epidemiological purposes-
Important as may be only site to yield
isolate, especially, if antibiotics have been
given
Throat swab – a full sweep of the
pharyngeal wall and tonsils, from all
patients. If not possible, obtain a pernasal
swab rotated on the posterior pharyngeal
wall.
Microbiology, haematology, nephrology,
infectious diseases and infection control
input may be helpful
Continuous renal replacement therapy
(CRRT) -
Veno-venous haemofiltration,
haemodiafiltration and plasmapharesis are
all used in the management of severe sepsis
Aggressive correction of
coagulation defects is essential
to optimise outcome
Maintain:
• Hb 7.0 – 9.0g/L
(according to co-morbidity)
• PT and APPT 1.5g/L
• Platelets > 20 x 10 9 /L
• ACT of 150 – 200
Monitor epidemiology of bacterial
sepsis and meningitis. Of critical
importance in era of introduction
of ‘meningitis vaccines’
Early rather than delayed CRRT
may be beneficial
16. NOTIFY PUBLIC HEALTH and
INFECTION CONTROL as soon as
possible
Ensure contact chemoprophylaxis and
information as per agreed protocol if
necessary (See Chapter 7,8,9,Appendix
4)
Under the statutory Infectious Diseases Regulations 1981, amended 2003, cases
or suspect cases of bacterial meningitis or meningococcal septicaemia must
be notified immediately to the relevant department of public health (medical
officer of health). Telephone notification should be used initially and this is the
responsibility of the admitting team. This should be done as a matter of urgency.
All telephone notifications must be followed by written notification.
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