We were saddened to read about the inquest into the death of Layla Ermenekli, a six year old girl who died hours after being sent home from an emergency department in Manchester, UK. Layla had a temperature of 38.1, was lethargic, had a headache and stomach ache and had a rash on her hip. She was diagnosed as suffering from a “viral infection” and was sent home. Layla subsequently died of meningococcal meningitis, a type of bacterial meningitis, and sepsis.
Meningitis is inflammation of the membrane surrounding the brain and spinal cord caused by an infection, viral or bacterial. Viral meningitis is more common than bacterial meningitis, is generally less severe and often resolves without treatment.
Bacterial meningitis is typically more severe and can quickly lead to sepsis and become deadly. Sepsis occurs when the bacterial infection enters the bloodstream. Chemicals released by the body to fight the infection trigger an inflammatory response which can cause tissue damage and multi-organ failure. Delayed diagnosis of bacterial meningitis can result in brain damage, hearing loss, learning disabilities and amputations. Due to the speed at which bacterial meningitis can cause severe damage, even a slight delay in diagnosis and treatment can have devastating consequences, especially for babies and young children.
Symptoms of meningitis include fever, drowsiness, confusion, vomiting, muscle pain, purple or red spots on the skin and neck stiffness. It is diagnosed by way of blood culture, imaging and/or lumbar puncture. Blood cultures refer to samples of blood that are placed in a dish and monitored for growth of microorganisms. CT scans or MRI scans may be ordered to assess swelling or inflammation of the brain. X-rays may show inflammation in other areas of the body. A lumbar puncture, known as a spinal tap, can be carried out to allow the testing of cerebrospinal fluid (CSF). A CSF sample will confirm meningitis is there are increased glucose levels and an increase in white blood cells and protein.
The first line of treatment for bacterial meningitis is intravenous antibiotics. Additional medications may also be required to treat shock and brain swelling. Unfortunately, the commencement of antibiotics can be unnecessarily delayed, resulting in catastrophic injury. Symptoms of meningitis in babies and young children can be misdiagnosed as symptoms of other less serious illnesses.
The Coroner presiding over the inquest into Layla’s death found that a window of opportunity to prevent her death was missed due to a “barely perfunctory” examination by a junior doctor during which Layla’s rash was dismissed as a bruise. The Coroner found that evidence given by the examining doctor at the inquest was “completely unreliable” and that the doctor had been “less than honest” with medical colleagues.