Doctors and scientists, including leading authorities on infectious diseases and immunology at the Great North Children’s Hospital, say that they are hopeful recent developments in research will lead to a simple, rapid two hour blood test which can determine whether a feverish child has a common virus or life-threatening bacterial infection such as meningitis, sepsis and pneumonia.
Dr Marieke Emonts – le Clercq, Consultant Paediatrician specialising in Infectious Diseases at the Great North Children’s Hospital and honorary Senior Clinical Lecturer at Newcastle University, is the clinical lead in Newcastle for patient recruitment and collecting information about how those patients at highest risk have reacted, both to their condition and the treatment given.
Dr Emonts explains: “Newcastle has an international reputation for its work into immunocompromised children with clinical care based on both the Bubble Unit and our oncology wards at the Great North Children’s Hospital.
“We have great experience in translational research and developing new and innovative treatments for young patients with serious, life-threatening conditions, with hugely successful results, so we are extremely well placed and very proud to help lead the way in this important field.”
Identifying bacterial infections
The early symptom of most infections is a high temperature reaching to feverish levels. The difficulty is distinguishing between viruses and bacteria, yet this is vitally important.
Dr Emonts continues: “Fever is one of the most common reasons we see children brought into our hospital. In fact around 25% presenting to the RVI’s Children’s Emergency Department do so for fever.
“Thankfully the majority of children will simply have a viral infection which can be easily treated to bring the temperature down. However, we know from intelligence already gathered that 1 out of every 100 children we see will have a bacterial infection which if not treated immediately, can become fatal.”
The international collaboration has already identified two genes which become activated by the child’s immune system when they have a bacterial infection. If the team can test the condition of these genes rapidly through a blood test, they can get the right treatment started immediately.
The work will start soon within the Newcastle hospitals, particularly the RVI, so parents and their children attending A&E might be asked to take part in the research project.
Use of antibiotics
For the time being, when a child is admitted to hospital with a worrying fever, there is a scoring system in place to help staff identify children who may be at higher risk of a bacterial infection. Diagnosis can only be made by taking a sample of blood or spinal fluid and using this to see if bacteria grow. However, this can take over 48 hours. At the current time, there is no way of rapidly diagnosing whether it is due to a viral or bacterial infection.
Because of the time taken for results to come back, doctors automatically start antibiotic treatment for any child they are particularly worried about. More often than not they will find a viral infection and they have had antibiotics unnecessarily.
Overuse of antibiotics can lead to resistance to antibiotics. This is because the antibiotics kill off most of the bacteria, but there will always be a few that are resistant. They then multiply, propagate and pass on their resistance to other bacteria which pose a real threat for the future.
Dr Emonts continues: “We currently have a huge dilemma on our hands. We certainly don’t want to miss any bacterial infections, but conversely, we are doing all we can to reduce the unnecessary use of antibiotics. Additionally, we really don’t want to be carrying out lumbar punctures to take spinal fluids for testing unless absolutely necessary. So a rapid test based on the two genes we believe we have identified could literally transform clinical practice and stop meningitis and sepsis in its tracks.”
This study is part of the Newcastle Academic Health Partners, a collaboration involving Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle University, and Northumberland, Tyne and Wear NHS Foundation. This partnership harnesses world-class expertise to ensure patients benefit sooner from new treatments, diagnostics and prevention strategies.
Professor Helen Foster at Newcastle University is the Children’s Clinical Research Speciality Lead at the Clinical Research Network North East and North Cumbria. She said: “Sepsis is a potentially fatal condition and the ability to identify those children who have life threatening sepsis from the myrriad of other causes of fever, will be a great advance in paediatrics. This is an excellent example of translational research – taking the clinical problem to help understand the basic science and then taking the basic science back to the clinical situation to improve patient care and potentially save lives."
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