Childhood emergencies

May 2010

FocusChildhood emergencies

Meningococcal sepsis

Volume 39, No.5, May 2010 Pages 276-278

Shabna Rajapaksa

Mike Starr


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 hospital transfer.

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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