Group A streptococcal
Evelyn Katie Lawlor (Evie) was a normal happy 19 month old when she developed what we thought was a routine cold one Saturday in June 2011. That night she started vomiting and running a fever, and after she vomited up her Calpol on Sunday morning I took her to the doctor unsure what to do next. We were told it was likely viral and to keep going with fluids and Calpol/ibuprofen. She was very subdued that Sunday but kept down water given little and often.
Monday morning she was still wiped out in herself and vomiting anything other than water so she went to the GP, but the same advice was given. She stayed home for the day with her daddy.
That night when I came in from work I picked her up and noticed a worrying rash on her arms and legs, including the soles of her feet and palms of her hands. In her case it was not a totally typical rash for meningitis/septicaemia as it did fade, but only in part and was a deep red colour rather than the purple. It was enough to worry me and I rushed her straight to A&E where they too were concerned enough to start immediate treatment with IV fluids and antibiotics, taking bloods at the same time. Her blood pressure was very low and they had a lot of problems getting IV access.
About two to three hours later things looked a lot more serious to them when her blood results showed her C-reactive protein levels in excess of 700, and we were told this was probably meningitis. Actually it later turned out that Evie had Group A streptococcal septicaemia and not meningitis.
The South Thames Retrieval service were called down from London to collect her and it took them (working with our local hospital team) over four hours to get her stable enough to transport. She was rushed to the Evelina Children’s Hospital intensive care unit where she was on a ventilator and required a lot of blood pressure support for several days, the most terrifying time of our life all in all.
She ballooned up with all the fluids she had so that she was just a swollen little person lying there, nothing like our little girl. Her ongoing IV antibiotics were changed to more targeted antibiotics once the Strep A was identified from her blood after the first 24 hours. She also had steroids and immunoglobulins, blood transfusions and platelet transfusions. Her kidneys started to fail and she was put onto dialysis after eight days in hospital but was lucky to only require that for a few days before her kidneys were able to cope alone again. Her right foot started to discolour over the front third on the first day in intensive care due to the blood supply being compromised. She had some improvement in her foot pulses a few days later but she will still lose a part of her foot and we are still uncertain how much that will be as this problem is ongoing.
She spent ten days in intensive care, a further 11 days in hospital after that, and now (July 2011) just over four weeks since this all began (foot aside) she is home and doing really well. We are so grateful to everyone involved in her care for helping us to be able to save our little girl and bring her home again. Our hope is that she will adapt well with her foot in time being so young.
We had seen the meningitis and septicaemia leaflets in the past, noted what they said and never expected to need to use that information. Please trust your instincts if something doesn't seem right and go back to the doctors. We don't blame the doctors who saw Evie before the rash appeared but it does show how hard this can be to detect in the early stages and that not all cases as typical. Even the infectious diseases team at the hospital wanted photographs of her rash as it was not typical.