Jack's Illness

Jack’s illnesses included Staphylococcus Aureus, Pericardial Rub, Pericardial Effusion and Pericarditis which ultimately claimed his life.

Here we tell the story of Jack’s illness and how it progressed, along with how a catalogue of events meant the underlying bacterial infection was missed.

“If sharing Jack’s story helps to save the life of even one other child it will be worth it”.

 

The reason we are sharing Jack’s personal information with you is that at the point we realised just how seriously ill Jack was, we searched the internet for any information we could find.  We have, quite naturally and sometimes obsessively, hunted for some kind of explanation as to what happened to our son and brother. There was little or no helpful detail, especially when it relates to someone aged 9.  It felt as though this has never happened to anyone else.

Suspected Virus and Sickness

Jack became ill with what was suspected to be a virus, he bore the pain with courage, dignity and bravery. He soldiered on and continued to impress with his commitment and dedication to all. He did his school work, homework, competed in hockey tournaments and swimming galas, attended play rehearsals. All this was because he never wanted to let people down.

Jack’s early symptoms, like so many young children, were just that he seemed a bit under the weather which was quite unusual for Jack as he was very rarely ill.

Jack returned from a school ‘team building’ trip on Friday, 14 February 2014. If anything he just seemed to have no sparkle, but he’d just spent a week doing activities with his friends away from home. He really wanted to attend a rugby day on the Saturday so he went along, but after having a bacon butty breakfast the match was abandoned due to torrential rain. It was around this time that he seemed a little lethargic and lacked his usual appetite – he wasn’t really what you would call a big eater, he was a grazer.

On Sunday, 16 February Jack had one really bad bout of sickness. He seemed a little offside throughout the half term, but nothing that seemed particularly excessive or unusual.

He was then sick a second time one week later on Sunday, 24 February.

That is two single bouts of sickness on two consecutive Sundays, so he wasn’t allowed to go into school immediately after the half term giving the usual 48 hours after the sickness, but was desperate to go in. He did return as soon as he could.

Jack then seemed well enough to go to school and it wasn’t until late afternoon of Friday, 7 March that he was sent home from school with a temperature over 40°C / 104°F and knee joint pain. Apparently Staphylococcus Aureus can cause joint pain.  Jack’s Grandad collected him and they walked home.

As soon as his Mum saw him fast asleep on the sofa she knew that he wasn’t well and took him straight to the local walk-in centre, because it was too late to go to their own GP. Unfortunately, an appointment was needed and as this was after 5.30pm on a Friday evening the only option was to go to  Accident and Emergency, which was also nearby.

He had been given the usual child paracetamol at school for a temperature over 40°C / 104°F. Jack was not a complainer, but he was also saying he had a very painful knee joint.

First Visit to Accident and Emergency (A&E)

Arriving early on Friday evening,  7 March, A&E did have an initial problem with beds, bays and waiting times, but a consultant improved the situation, Jack was thoroughly checked and observed over several hours with a urine test being taken and, as far as Jack’s Mum understood, there was nothing to worry about in those results. No obvious cause for the symptoms, other than a virus, was concluded or possibly even noticeable,  It looked to Jack’s mum as though this really was a nasty virus from which he would take weeks to recover.

Relieved that this was the diagnosis, Jack was taken to the comfort of his own home to rest and recover. The hospital consultant apparently wrote to the GP, although his Mum wasn’t aware of this.  The letter hasn’t been seen by the family, but the indication at the inquest seemed to be that the GP was asked to monitor Jack’s progress.

Jack’s Mum was told it was most likely a virus and to continue with child’s paracetamol. At this point his family very clearly understood it would take several weeks for him to fully recover. This is something his Mum mentioned to other school parents who were obviously asking after Jack’s health. She did as she was asked … as any of us might still do.

Throat Closing

As so many parents would and not wishing to hassle the medical profession unduly, Jack’s parents persevered with the diagnosis giving him the usual childhood remedies to keep his temperature and any pain under control.  He seemed to recover sufficiently to attend and win at a swimming gala on Monday, 24 March 2014.  His teachers were happy enough for him to swim and were closely monitoring his well being as requested by his parents.  It seems there was no obvious reason to say he couldn’t take part.

The next day, Tuesday, 25 March 2014 Jack got up to go to school, but he complained that his throat had closed.  He didn’t seem to be able to settle or get comfortable.  His complaints were such that his mum arranged for him to see his GP as soon as possible.  An appointment was made for 8.20am.  This was before the usual school run for her other children so clearly she considered this to be necessary quite urgently. The GP indicated that these symptoms were still part of a virus.   A blood test was requested, but – while Jack’s Mum thought this would be the same or next day – an appointment was made for Friday, 28 March.  She was becoming more worried that Jack seemed to be getting worse.  The help of a family friend was enlisted and the blood test was brought forward  to Thursday, 27 March 2014.

Can’t Sit Down or Lie Down Properly

It was from the Wednesday, 26 March that Jack deteriorated even more rapidly and couldn’t seem to lie down and often did not want to sit down. He was generally uncomfortable. He struggled to sleep and was propped up on pillows. This was later discovered to be because he had a Pericardial Effusion (fluid around the heart).

Outline information only to very briefly explain medical terms we use. These are not written by a trained medical professional so please speak to your own experts.

Pericardial Effusion:   Having spoken to many GP’s since Jack’s death it has become apparent that it can be quite difficult for a GP to recognise a Pericardial Effusion.  A pericardial rub (noise) can possibly be heard when using a stethoscope, but this often takes a very experienced GP or consultant and can be missed during these general consultations.  There are much more detailed and accurate explanations for Pericardial Effusion on various sites via the internet, but if you have any concerns you should always seek medical advice from your GP, NHS Helpline or the local hospital.  These professionals should be able to explain this in full.  If you are not satisfied with the first evaluation, please ask for someone else to see your child.

Pericardial Friction Rub also known as Pericardial Rub, is an audible medical sign used in the diagnosis of Pericarditis. Upon listening with a stethoscope, this sign is an extra heart sound of to-and-fro character, typically with three components, one systolic and two diastolic.

Pericardial Effusion:   Chest pain or pressure are common symptoms, however a small effusion may be asymptomatic meaning that the patient may not experience any symptoms.  Jack didn’t have chest pain.

The Wikipedia entry for Pericardial Effusion at the time of first creating this website  is included below: (it is always advisable to check latest information by talking to your medical team):

Pericardial effusion (“fluid around the heart”) is an abnormal accumulation of fluid in the pericardial cavity. Due to the limited amount of space in the pericardial cavity, fluid accumulation leads to an increased intrapericardial pressure which can negatively affect heart function. A pericardial effusion with enough pressure to adversely affect heart function is called cardiac tamponade.

 

 

Jack Grunting and Complaining Of Severe Pain Throughout His Whole Body

Blood Test Results and Admission to Hospital.

By now becoming more and more concerned, but still believing this to be a very nasty virus from which Jack would eventually recover, his parents managed to arrange, directly with the hospital, for the blood test to be brought forward to Thursday, 27 March. Jack was making a strange noise with his throat, a grunting noise, presumably in an attempt to catch his breath, but this was something of which his family had absolutely no understanding.

The results were available that same afternoon, but, the GP’s surgery was closed. As soon as the results were available the following morning, Jack’s parents asked for a GP review which was indicated would be early the following week. Completely exasperated, Jack’s dad insisted it was done on the Friday.  By this stage Jack was so very poorly that his Mum and Dad were extremely worried.   Jack was seen by his GP late on the Friday afternoon, who requested that Jack come back the following Tuesday to have a blood test to check for glandular fever.   As he left the doctors Jack was complaining of severe pain elsewhere in his body too – the fluid was settling lower in his body.

Jack’s dad insisted on a referral to the local children’s ward, where Jack was carried into the hospital by his Dad and it was clear to the consultant that he was very seriously ill. A prompt chest X-ray was arranged.  Jack was started on a course of antibiotics for what his Mum and Dad assume was a bacterial infection and they , also assume that the blood tests were reassessed/repeated. The original blood tests done on 27 March showed a C-Reactive Protein (CRP) of 169. At the inquest one of the medical professionals from Birmingham Children’s Hospital gave the description that  ‘anything over 10’ should flag concern.

 

Blood Test - Cause For Concern and Shadow On X-Ray

Prior to Jack’s admission to hospital Jack’s parents were still unaware that the blood test results were causing any concern until the inquest.  The resulting x-ray showed the left side and centre of his chest as black shadow, identifying what the consultants described as a pericardial effusion* (excess fluid in the pericardial sac around the heart).  Below is an example of an x-ray of a Pericardial Effusion.  This is not Jack’s x-ray result.

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Source: http://medlibes.com/entry/pericardial-effusion

Stunned and numb, Jack’s family braced themselves for him to be moved to Birmingham Children’s Hospital (BCH).  Jack went with his parents, via Kids Intensive Care Ambulance, to BCH Paediatric Intensive Care Unit (PICU) on Saturday, 29 March 2014 where he was reassessed as to whether the fluid needed to be drained.  The consultants opted to monitor him very closely over the weekend, while continuing with a concoction of medication.  They had apparently seen a similar case a few months earlier where the fluid had dissipated without the need to drain.  It appeared that the least invasive the treatment the better.

Chest Drain Fitted and Identification of the bacteria Staphylococcus aureus

By the Sunday evening, 30 March, the consultant at Birmingham Children’s Hospital (BCH) decided it was necessary to fit a chest drain to afford Jack some relief from discomfort and to find out more about what was causing the build-up of fluid.  This was done the next day, Monday, 31 March.   Samples of the fluid from within the pericardial sac were taken and the staff at BCH identified from this that Jack’s system had been affected by the bacteria Staphylococcus aureus  which it appeared to the family was the likely cause of the Pericardial Effusion.

Jack, whilst still extremely poorly, did improve enough over the next couple of days to eat a little better, as well as to be able to play with his Lego and iPad.  This photo of Jack was taken on Thursday, 3 April 2014.  Jack died that evening.

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The information below is not provided by a medical expert.

Staphylococcus aureus is a bacteria frequently found in the human respiratory tract and on the skin. In many cases it causes no harm, but if it enters the blood stream, through boils, cuts, open wounds, via urine infections, toxic shock syndrome or by being ingested it can cause serious illness and even death.  This list is not exhaustive and is taken from general information available on the internet.  Please always check your symptoms with your own medical team/local hospital.

There was no clinical evidence to identify how the bacteria entered Jack’s body.  The coroner found no cuts, boils, scars.  The family have no idea how he contracted this illness.

Useful references: Search the internet for Staphylococcus aureus (symptoms, information, causes, etc), talk to your GP and health professionals for the latest information available. NHS Choices and Wikipedia.

Check what to do if affected by the following.

Staphylococcus Aureus & Food Poisoning, Staphylococcus Aureus & Sport (changing rooms, shared kit, mouth guards, astro turf, etc), Staphylococcus Aureus & Institutions (hospitals, schools, swimming pools/whirlpools and appropriate disinfection, etc), Staphylococcus Aureus & Toxic Shock Syndrome

Removal Of Heart Monitor

The medical team, seemingly believing he was still very poorly but recovering, took Jack off his heart monitor.  It seemed to Jack’s family and friends, from the inquest, that these professionals thought from Jack’s appearance and his ongoing tests that he seemed to be in recovery, albeit that it would be slow.  He was still assessed by having a regular echocardiogram as well as other observations.  Jack even had a go at administering the echo himself.  He was indeed still very poorly and continued on his course of several different antibiotics, but it seemed Jack had, as his mum described it, “at last turned a corner” and was on the road to recovery.

Jack’s medical team mentioned at the inquest that the treatment infectionmarkers were showing that he was responding to treatment.   There was no underlying heart condition and no one suspected what was to happen.

His family could at last feel a tiny bit of relief.  His Dad, was just about reassured enough by the way Jack was, to attend his youngest daughter’s Choral Society Concert in which she was to sing a solo. That solo never happened as his Dad received a message to go to the hospital and the concert was stopped very briefly while he gathered his children to go to Birmingham.

Jack's last hours

Jack spent his last hour trying to Facetime his family. They were, of course, in church at the concert.

Jack suddenly complained of back pain in the evening of Thursday, 3 April 2014 and tried to get out of bed.   He fell into his mum and eldest sister’s arms.  Emergency resuscitation was started almost immediately on Jack.  Despite the very best efforts of the medical teams involved that night, Jack was eventually pronounced dead following surgery in PICU later that evening. He had suffered a cardiac arrest and the cause of death was initially inconclusive, but ultimately Natural Causes due to Pericarditis.

On Sunday, 6 April 2014, after he passed away Jack should have been competing in the British Schools Modern Biathlon at the Olympic Park in London. His friends somehow managed to go ahead with this competition out of respect for Jack.  We mention this to explain just how fit a young man Jack had been and also how much he was loved by everyone he met.

Coroner’s Report

The inquest nor the post mortem explain how the bacteria managed to enter Jack’s body.  He had no cuts or boils, etc, evident.  How this happened may always remain a mystery.

Information from Jack’s Post Mortem describes most areas as ‘unremarkable’ with the exception of Pericarditis.

 

Outstanding Questions

Questions his family and friends ask over and over remain: why is this fit young man no longer here? How long does it take for Staphylococcus Aureus to cause such destruction to a heart and should anyone in the medical field have known he had this bacteria sooner?

It seems that these questions will always remain just that … unanswered questions.

“We want to ‘make a difference’ and to ensure that Jack William Dulson is never forgotten.”

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