Document Page: First | Prev | Next | All | Image | This Release | Search
File: 123096_sep96_decls23_0027.txt
Subject: DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANCE
Unit: OTSG
Parent Organization: HSC
Box ID: BX003203
Folder Title: DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Document Number: 1
Folder Seq #: 88
B. Signs: 6. Coagulation: prothrombin time (PT) and partial
1. Meningococcemia: thromboplastin (PTT) time may be elevated in
fever meningoeoccemia. Evidence of DIC, including
tachycardia decreased fibrinogen levels, and elevated levels
generalized muscular tenderness of fibrin degradation products may be seen.
petechiae/purpura/ecchymoses - both skin and
mucosal D. X-ray: nonspecific.
hypotension
altered mental status E. Invasive procedure:
1. In presence of meningitis or suspected meningococ-
2. Meningitis: cemia, lumbar puncture for CSF should be performed
headache
fever immediately, unless papilledema or focal neurolo-
gic signs are present, suggesting intracranial
meningismus/stiff neck mass or increased intracranial pressure.
ould be tested for glucose, protein, cell
III, vii, Viii) count, gram stain and culture. Counter-im-
altered mental status munoelectrophoresis against meningococci, pneumo-
seizure cocci, and liemor)hilus influenzae may be helpful if
positive Kernig's sign available.
3. CSF results:
C. Laboratory: a. glucose = < 40 mg/dl (in 75% of cases).
1. Hematologic: b. protein = 150 mg/dl (range 25-800).
a. meningococcemia: C. WBC > 1000 cells/mm, PMN predominant (range
i) HGB/HCT: nonspecific. 10-65,000, lymphocyte predominance is seen it)
ii) WBC: leukocytosis or leukopenia (leuko- < 10%.
penia implies more fulminant illness).
iii) thrombocytopenia: common. F. Diagnostic confirmation: culture of organism from
b. Meningitis: clinical specimen (from blood, CSF, or petachial
i) HGB/HCT: nonspecific. aspirate).
ii) WBC: leukocytosis more typical, leuko-
penia suggests sepsis/neningococcemia. IV. Duration:
iii) platelets: usually normal
thrombocytopenia suggests sep- A. Treated: clinical response should occur within 48
sis/meningococcemia. hours. Duration of convalescence depends on severity
iv) CSF: see below. of illness and its complications.
2. Chemistries: nonspecific; serum glucose and
protein should be obtained for comparison against B. Untreated: death may occur within minutes to hours.
CSF values. Mortality is extremely high.
3. urinalysis: nonspecific.
4. microbiologic: V. Complications: shock, disseminated intravascular coagula-
a. CSF Gram stain: positive in 50-90%, includ- tion (DIC), adult respiratory distress syndrome (ARDS),
ing meningococcemia without clinical menin- pericarditis including tamponade, pneumonia, diabetes
gitis. Organisms may be present prior to insipidus, cranial nerve palsies, prolonged mental status
WBC'S. changes.
b. CSF culture: positive in 50-90%, including VI. Treatment:
meningococcemia without clinical meningitis.
C. Blood culture: positive in 50-60%.
A. once meningococcal disease is suspected, treatment must
should be prepared as soon as CSF is obtained proceed simultaneously with the diagnostic evaluation.
from patient. 1. Obtain rapid history and physical exam, identify-
5. Serology: not applicable. ing contraindications to lumbar puncture.
4 4
45
Document Page: First | Prev | Next | All | Image | This Release | Search
Document 52 f:/Week-36/BX003203/DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS/diagnosis and treatment of diseases of importanc:12179609281524
Control Fields 17
File Room = sep96_declassified
File Cabinet = Week-36
Box ID = BX003203
Unit = OTSG
Parent Organization = HSC
Folder Title = DIAGNOSIS AND TREATMENT OF DISEASES 1991PORTABLE FIELD PERSONNEL SHOWER SYSTEMS
Folder Seq # = 88
Subject = DIAGNOSIS AND TREATMENT OF DISEASES OF IMPORTANC
Document Seq # = 1
Document Date =
Scan Date =
Queued for Declassification = 01-JAN-1980
Short Term Referral = 01-JAN-1980
Long Term Referral = 01-JAN-1980
Permanent Referral = 01-JAN-1980
Non-Health Related Document = 01-JAN-1980
Declassified = 17-DEC-1996