Dr Nellie Thwaites: 'The boy came in alert. Hours later, his organs were packing up'

My toughest case
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Indy Lifestyle Online

I'm a consultant paediatrician and the case of a little boy who was about 18 months old really changed the course of my career. He had seemed a bit unwell and his mother had been anxious about him and taken him to the GP, who thought he simply had a viral illness. However, the boy's mother was unconvinced: he wasn't himself; he'd become pale, wasn't playing and his breathing was a bit funny.

She felt that this was very odd for him, so she brought him to St Mary's, the hospital where I was working as a paediatric intensive care registrar at the time.

When he came through the doors of the accident and emergency department he had developed one purple spot on his tummy. That is always very worrying in a child who is pale, irritable and has a fever, because it is the hallmark of a condition called meningococcal septicaemia, which often gets called meningitis – but it isn't meningitis, it's blood poisoning, which is much worse. One hundred years ago a doctor in America described it as an illness that slays more quickly than any other infection.

At the time the boy was still alert and communicating with his mother, but in a matter of hours we saw him transformed into a child with extreme multi-organ failure. A terrible black rash had appeared all over his body, his kidneys and breathing were packing up, his heart wasn't working properly.

But because he'd come through the doors of St Mary's, which at the time had a specialist intensive care unit for meningococcal infections, he was immediately put into the intensive care unit, where for the next 24 hours a battle ensued to stabilise him and save his life. What's terrible about this infection is a child can be alive and apparently stable one minute and dead the next, which is a really horrific thing for parents and doctors to see.

In the end he had a couple of amputations, a few fingers and a bit of his foot, but nothing that he couldn't cope with for the rest of his life. He was actually quite lucky because many children with this condition end up losing much more.

But seeing the speed of devastation made me want to know more about how this disease presents itself in the community, so I was funded by the Meningitis Research Foundation to do a big national project. From that work has come a lot of information which has been disseminated around the country and I think a lot of good has come from what was really a terrible case. I've been a doctor for 22 years now and there are some patients and experiences that you just don't forget.



The Meningitis Research Foundation is petitioning the Government to add the new Meningitis B vaccine (when it has received its approval and license from the European Medicines Agency) to those recommended for all infants. www.meningitis.org

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