Center for Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
BMC Fam Pract. 2021 Nov 30;22(1):240. doi: 10.1186/s12875-021-01585-8.
An early appropriate response is the cornerstone of treatment for invasive meningococcal disease. Little evidence exists on how cases with invasive meningococcal disease present at first contact to emergency medical services.
Retrospective observational study of cases presenting with invasive meningococcal disease from January 1st of 2016 to December 31st of 2020 in the Capital Region of Denmark with a catchment area population of 1,800,000. A single medical emergency center provides services to the region. Data was collected from emergency medical services' call audio files, data from the call receiver registrations, registrations from ambulance personal and electronic health record data from the hospitalization.
Of 1527 cases suspected of meningitis, 38 had invasive meningococcal disease and had been in contact with the emergency service. Most contacts were to the medical helpline rather than the emergency call center at initial contact to emergency medical services. All were hospitalized within 12 h. At initial contact, fever was present in 28 (74%) of 38 cases, while specific symptoms such as headache (n=12 (32%)), a rash or petechiae (n=9 (23%)) and stiffness of the neck (n=4 (11%)) varied and were infrequent. Cases younger than 18 years of age were more often male and more often presented with fever and rash/petechiae. Only 4 (11%) received prehospital antibiotic treatment.
Cases with invasive meningococcal disease presented with fever and unspecific symptoms. Although few were acutely ill at their initial contact, all were admitted within 12 h. We suggest that all feverish cases should be systematically asked about specific symptoms and should be wary of symptom progression to optimize the early management if cases with invasive meningococcal disease.
及时恰当的治疗反应是侵袭性脑膜炎球菌病治疗的基石。关于侵袭性脑膜炎球菌病患者首次接触急救医疗服务时的表现，相关证据很少。
对 2016 年 1 月 1 日至 2020 年 12 月 31 日期间在丹麦首都地区就诊的侵袭性脑膜炎球菌病患者进行回顾性观察性研究，该地区的服务对象约有 180 万人。整个地区仅有一个医疗急救中心。研究数据来自急救医疗服务的呼叫音频文件、呼叫接收登记、救护车人员登记和住院电子健康记录。
在 1527 例疑似脑膜炎的患者中，有 38 例患者确诊为侵袭性脑膜炎球菌病，并与急救服务取得了联系。在首次接触急救医疗服务时，大多数患者拨打的是医疗热线，而非急救中心电话。所有患者均在 12 小时内住院治疗。在首次接触时，38 例患者中有 28 例（74%）存在发热，而头痛等特定症状（n=12（32%））、皮疹或瘀点（n=9（23%））和颈部僵硬（n=4（11%））的出现则较为少见且并不常见。年龄小于 18 岁的患者更常为男性，且更常出现发热和皮疹/瘀点。只有 4 例（11%）患者接受了院前抗生素治疗。
侵袭性脑膜炎球菌病患者的首发症状为发热和非特异性症状。尽管他们在首次接触时多数没有急性症状，但所有患者均在 12 小时内住院治疗。我们建议对所有发热患者均应系统询问特定症状，并警惕症状进展，以优化对侵袭性脑膜炎球菌病患者的早期管理。
