Meningococcal disease remains a significant illness with
an overall mortality of around 8%. The majority of deaths
occur in the first 24 hours, before the commencement of
specialist care. Missing a diagnosis of meningococcal
disease is a fear among health care practitioners.
This article presents a guide to identifying the salient
features of meningococcal sepsis and initial management
strategies in the primary care setting.
Initial presentation is often nonspecific and therefore it
is important to have a high index of suspicion in children
presenting with fever, lethargy, myalgia, vomiting and
headache. These children should be monitored and
reviewed carefully. If a nonblanching rash develops,
immediate treatment, liaison with a paediatric intensive
care unit and urgent hospital transfer is required. Initial
management involves assessment and regular review of
airway, breathing and circulation. Antibiotics (preferably
intravenous cephalosporin) should be administered before
Meningococcal disease, presenting as either meningitis or septicaemia, remains a significant illness, even with the introduction of the conjugate meningococcal C vaccine. Meningococcal disease is caused by the bacterium Neisseria meningitidis and mainly affects children under the age of 5 years and adolescents. The overall mortality of the disease is around 8% (5% for meningitis and 15–20% for sepsis), which is improved significantly with the early administration of antibiotics.1–3 The majority of deaths occur in the first 24 hours, before the commencement of specialist care and therefore the challenge for first line physicians is to identify those patients who will progress from nonspecific early presentation to fulminant disease.4
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