Doctors' meningitis hunch saves four

Paediatricians used experimental blood-cleansing treatment to kill infection

JOHN ARLIDGE

Scotland Correspondent

Doctors in Glasgow have made an important breakthrough in treating the most severe form of meningitis which can kill a patient in just a few hours.

Paediatricians at Yorkhill NHS Trust, Britain's second largest children's hospital, say experimental treatment carried out on four patients who contracted meningococcal septicaemia shows that early dialysis - blood cleansing - can help to kill the infection. They are urging other doctors to try the method to treat this comparatively rare form of the disease.

The four children - three girls and a boy aged from 2 to 12 - were close to death when they were admitted to the intensive-care unit at Yorkhill last year. Doctors, alarmed by the speed with which the meningococcal infection had spread through their bodies, decided to administer dialysis immediately rather than waiting for signs of kidney failure.

Despite this early treatment, consultants expected at least three of the four to die within days. They were astonished when, one by one, the children began to recover. Although three had limbs and toes amputated when the poisoned blood in their legs clotted, all four have now been discharged and are back at home with their parents.

The Yorkhill paediatric intensive care team, led by Dr Crispin Best, decided to administer the dialysis as a simple experiment. "We knew that it helped in the later stages of the disease and we wanted to see what would happen if we tried it sooner," Dr Best said yesterday."We had a hunch it might work."

Dr Best said he was surprised at the success of the treatment. "This form of meningitis is the bacterial equivalent of being run over by a speeding truck. It is a vile, deadly disease and there was great relief when the children's conditions began to improve." It was too early to claim that the discovery would lead to a cure, he said, but "our clinical impression is that the early use [of dialysis] is potentially life-saving in this terrible disease."

He added: "There is no such thing as a cure. This is a devastating illness. A patient has no defence against it. Meningitis is a bacterial infection of the lining of the brain. What happens is the organs in the body start running out of control. Everything starts clotting."

Doctors and researchers at the hospital, who publish their findings in today's edition of the Lancet, admit they do not know how the dialysis treatment works - only that it does. One theory is that filtering a patient's blood removes the toxins produced by the infection, making it easier for the body's immune system to recover and kill the infection itself.

Dr Best and his colleagues are calling on doctors around Britain to "try out" the technique as part of a nationwide survey to determine its effectiveness. Medical staff at the County Hospital in Lincoln have already begun to use the methods pioneered in Glasgow. "We are confident we are on to something but we need more information - a structured trial - before we can be sure."

Health service managers say the discovery is unlikely to affect other patients who need dialysis, such as those suffering kidney failure. Dr Douglas Arthur, clinical director of intensive care at Yorkhill, pointed out that dialysis machines are inexpensive and less than 100 people each year contract meningococcal septicaemia.

But, he went on: "Haemo- diafiltration is a time-consuming business and there could be resource implications for nursing staff. If intensive care units around the country started using this technique, they might have to train more staff."

At Yorkhill yesterday, Ellen Curran, the mother of three-year-old Jonathan who underwent the pioneering treatment, praised doctors' decision to opt for early dialysis. "Jonathan was given just six hours to live when he was admitted. There is no doubt in my mind that this treatment saved my son's life. He is back to his old self again - bright, cheeky and as far as I am concerned quite brilliant."