Bad Blood

Meningococcemia can kill its victims with stunning speed. But a new medicine tested by a Dallas doctor offers hope—if the FDA will approve it.

EVERY PARENT’S worst nightmare began for Gina Renfrow around five in the morning on February 19, 1995, when her four-year-old daughter, Brianna, woke her up and complained that her legs hurt. Renfrow didn’t think much of it. Brianna had played hard the previous day, and Renfrow figured her daughter simply had sore muscles. An hour later, however, the little girl was up again, this time complaining of feeling feverish. Renfrow gave her some Children’s Tylenol, and at Brianna’s urging, they started watching a video of the movie The Client. 

Renfrow, who had recently been divorced, was raising Brianna by herself in the Dallas suburb of Mesquite. “With a four-year-old, a low-grade fever hardly shows up on the radar,” she says today. But this wasn’t just any fever, and by eight, she and her daughter were at a PrimaCare clinic in Mesquite. Brianna “didn’t look right,” and she was delirious, Renfrow recalls. It was the height of the flu season and the clinic was crowded, but Brianna quickly got the staff’s attention when her temperature registered a dangerous 105.

Over the next three hours, nurses fed her more Tylenol and bathed her in cold water, eventually bringing her fever down a few degrees. Renfrow says that she was ready to take her little girl home when she noticed the tiny red spots that had begun to appear on Brianna’s abdomen. “At first the doctors said they were just a rash,” she says. “But they weren’t raised like a rash; they were beneath the skin.” (In fact, the spots were purpura, a discoloration caused by the leakage of blood from capillaries, and the most distinctive visual symptom of meningococcemia.) “Then one of the doctors took Brianna’s legs and pushed them up to her chest,” Renfrow continues, “and she just screamed something awful. That’s when he said it might be meningitis and we should go to Children’s Medical Center in Dallas.”

A little before noon, they arrived at Children’s, where, Renfrow says, “They treated it like a big emergency,” which surprised her. “Brianna was in a treatment room with so many tubes in her you couldn’t recognize her. The dots of her rash were turning into big blotches. There must have been ten doctors running in and out of there.”

The doctors explained that what Brianna had was worse than meningitis—that in fact she had a more advanced and deadly form of meningococcal infection known as meningococcemia. In the former, the bacteria confine themselves to the meningeal compartment (the skull and spinal canal); the infection, while serious, can usually be brought under control with antibiotics. In the latter, however, the bug gets loose in the bloodstream, where it incites a biochemical riot that moves so rapidly the immune system can’t keep up.

Meningococcemia hits the immune system with a double whammy: The bacteria themselves are bad enough, but the real danger is the huge amounts of endotoxins (poisonous substances in the outer membrane of the bacteria) they slough off as they roam about the bloodstream. These endotoxins trigger an exaggerated inflammatory response from the immune system, during which a victim’s blood vessels dilate or constrict when they shouldn’t, and blood either clots or leaks through damaged vessel walls.

Before long, the doctors explained to Renfrow, all the leaking would leave too little blood in Brianna’s vessels to support her heart and too much fluid in her lungs to allow proper respiration. Meanwhile, all the unwarranted clotting was making a stroke or heart attack imminent, and poor blood flow through the body’s tissues was triggering the deterioration of other organs—the kidneys and liver and muscles. Antibiotics worked sometimes, to some extent, they said, but not always. And even if they did save Brianna’s life, the ischemia (loss of blood flow) caused by the clotting as well as the constriction of blood vessels might necessitate amputating a limb. “It’s in the hands of a higher power,” one doctor said.

Renfrow was dazed. Less than eight hours earlier, her little girl had had sore legs and a minor fever. The idea that she was now near death seemed preposterous. “I knew Brianna was really sick now, but I didn’t think that she wasn’t going to be going home with me.” On through the afternoon the team of doctors and nurses worked on the child, feeding her more antibiotics, carefully monitoring her every breath and heartbeat with a battery of life-support machines. But at six that evening—just thirteen hours after Brianna first told her mom she felt ill—her heart failed and she died.

I just kept thinking, ‘How?’” Renfrow says. “Where did she get it? And I questioned myself. But a doctor told me, ‘Look, with meningococcemia, even if you’d been right here in the ICU when she broke out in a fever, we might not have been able to save her.’ I think he was right. I’ve never seen an infection move so fast. I didn’t have a chance to fight for her.”

When Brianna died, meningococcemia had been on something of a rampage in Texas: Between 1990 and 1995, the annual incidence of the disease had increased from 100 to 250 cases statewide (most of them in the northeastern part of the state), one tenth of the national total. The infection, which is equally deadly in children and adults, is generally spread by contact with an adult who is carrying the bug asymptomatically. Like many bacteria and viruses, it tends to flourish during the winter months. “There’s no lifestyle choice you can blame it on,” says one of the doctors who treated Brianna, pediatrician Brett Giroir. “You catch it just like the flu.”

About half of meningococcemia victims are under two, and most are under eighteen, because their immune systems haven’t fully developed. Up to 50 percent of them die, often, like Brianna, within 24 hours of the onset of symptoms; many of those who survive suffer such severe loss of circulation to their extremities that they require limb amputations. Most shocking of all, medical science is treating the infection pretty

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