Simple meningococcal disease test not used by doctors

A simple test that can aid diagnosis of meningococcal disease is not being used by most New Zealand medical practitioners.

The death of a Te Kuiti teenager has led a coroner to recommended that the Ministry of Health tell all practitioners of the test, along with protocols introduced by the Waikato District Health Board that could save lives.

Lindsay Poirangi Ngaru was a fit 17-year-old when meningococcal disease claimed his life on May 31, 2001.

His father, Luke, can still remember his son's fists clenched tight as he lay in a Te Kuiti Hospital bed, pleading with doctors to stop the pain as the disease took hold.

The teenager had earlier been misdiagnosed by a Te Kuiti doctor as having the flu and sent home with pain medication and paracetamol. Nearly four years on, Mr Ngaru still struggles as he talks about his son.

Te Kuiti coroner Wallace Bain heard at an inquest last year that the death of Lindsay and another teenager prompted changes to the way the disease was diagnosed in the Waikato region. Mr Bain's reserved findings show the changes have meant there has not been a meningococcal death in the region since - yet the coroner heard that the doctor who helped to introduced the changes had received wide criticism for his peers.

Dr Graham Mills told the inquest there had been wide debate about administering antibiotics so readily to patients when a diagnosis of meningococcal disease was not certain.

In June 2002, Waikato Hospital introduced a policy that people between 14 and 40 who had fevers and no alternative diagnoses from six possible illnesses were to receive intravenous antibiotics until blood culture results were received.

Dr Mills told the court he received wide criticism from doctors throughout New Zealand for the move, based on the philosophy that antibiotics did nothing to cure viral illnesses.

By July 2003, Dr Mills had added a test that is now used as a matter of course throughout the Waikato.

The procalcitonin test helps doctors to determine whether an illness is viral or bacterial. Viruses, such as influenza, will not respond to antibiotics but bacterial illnesses, such as meningococcal disease, can be treated.

Dr Mills told the coroner the test was used in a limited number of European countries but at the time it was not used in Australasia. Now Mr Bain has recommended that the ministry draw to the attention of all medical practitioners the protocols, practices and procedures adopted by the Waikato District Health Board, including the test.

A study on the effectiveness of the test is due to be released this year, but Dr Mills said that in the Waikato, one in four patients who returned positive tests for bacterial disease turned out to have meningococcal disease.

Mr Ngaru was pleased changes had been made to the way the disease was diagnosed, but said it was too late for his son.

"It's unfortunate that it takes something like that before people really take things seriously."