Meningitis and Meningococcal septicaemia (Meningococcal Disease) is caused by a deadly bacteria that can kill in hours. Meningococcal disease is notoriously difficult to diagnose as initial symptoms mimic those of common colds. Researchers at Queen’s University and The Belfast Trust are working to improve testing to prevent unnecessary deaths while at the same time reducing the number of children treated unnecessarily ‘just in case.’
Time is of the essence when it comes to treating meningitis, making it vital to treat it as early as possible. Most people make a good recovery if treated early enough but without treatment, many will die.
Meningococcal disease can be difficult to detect, with many patients only identified as infected when a visible rash develops, which is often too late. Furthermore, traditional laboratory diagnostic tests are slow taking up to 48 hours to return results.
It is estimated that 50% of patients who turn out to have meningococcal disease have been falsely reassured in the previous 12-24 hours by their doctor and are sent home given the all-clear though they may in fact be infected. For those patients who are sent to hospital, they will be offered treatment before doctors can officially diagnose whether they are infected. Because the early stages of meningococcal disease are notoriously difficult to diagnose, doctors in the UK tend to err on the side of caution resulting in the majority of suspected cases receiving precautionary treatment.
Professor Mike Shields, Clinical Professor at Queen’s University Belfast and Consultant Paediatrician at the Royal Belfast Hospital for Sick Children said: “If we suspect a child may have meningococcal septicaemia, we will administer antibiotic treatment straight away. If we wait a few days for the test results to confirm, it may be too late and we risk losing the child.”
Treating potential cases with antibiotics for 48 hours is the safest approach in treating potential cases until new, fast diagnoses are made available. However, this approach means that for every child with meningococcal disease, four children are being over treated.
A study led by Queen’s University Belfast and The Belfast Trust found that out of the 105 babies and children treated for suspected Meningococcal Septicaemia, only one third were later found to be infected meaning two thirds received treatment unnecessarily.
The NHS gold standard test (blood cultures) for detecting meningococcal disease can take up to 48 hours for results to come back. Researchers at Queen’s University in partnership with the Belfast Trust have developed a diagnostic test, known as LAMP (Loop Mediated Isothermal Amplification), which provides results within an hour. Throughout the two year study, researchers tested patients using both the standard NHS and the LAMP tests. The LAMP test proved to be as efficient as the standard test in returning accurate diagnosis though in a fraction of the time. Hibergene Diagnostics have now developed the LAMP test for commercial use.
Dr James Mc Kenna from The Belfast Care and Social Trust and lead researcher in developing the LAMP test said: “The LAMP test enables doctors to efficiently diagnose meningococcal septicaemia within an hour. The LAMP diagnosis could significantly reduce the number of patients taking medication unnecessarily as well as preventing needless anxiety to patients and their families.”
Dr McKenna added: “The test saves lives as well as saving precious time for hospital staff so the next stage is that this test can be made readily available to clinicians. When designing the LAMP diagnosis, we focused on producing a test that would be easy to use for clinicians in a hospital setting, taking away from what can be a timely cost of tests being performed by trained lab technicians.”
Although research has proven the LAMP test’s accuracy, further research is required to demonstrate the practicality of testing being undertaken by a clinician in a hospital environment.
Dr Tom Waterfield is leading a new research study at Queen’s University in collaboration with the Paediatric Emergency Research UK and Ireland (PERUKI) network to assess the practicality of this test being used in a hospital setting. Dr Waterfield explains: “We know that scientifically the test is effective but we now need the evidence base to confirm whether it is feasible for clinicians to carry out this test as part of their role before an informed decision can be taken. As part of this study, we will evaluate the feasibility of clinicians using the LAMP test in a hospital setting by assessing any potential barriers and ease of use.”
The two year research study, launching in September will involve clinicians in the Royal Belfast Hospital for Sick Children using the Hibergene LAMP test in the emergency department to test suspected cases of meningitis, getting results within the hour. If rolled out across the UK, the test could not only prevent children being admitted for treatment for meningococcal disease unnecessarily, but it could also stop children being wrongly sent home, potentially saving dozens of lives every year.
The work is funded by the Health and Social Care Research and Development Division, Public Health Agency and by the Royal College of Emergency Medicine.