The early management of meningococcal disease

Neisseria meningitidis is an important cause of bacterial meningitis, particularly in infants over three months old and in teenagers. The relative importance of meningococcal disease over invasive Haemophilus influenzae disease has increased following the introduction ofHib capsular vaccines in 1990. In about one fifth of infections with Neisseria meningitidis the organism causes a predominantly septicaemic illness.' Meningococcal meningitis and meningococcal septicaemia together constitute the spectrum of meningococcal disease. The overall mortality of meningococcal disease is around 8% (up to 5% in meningitis, rising to 15-20% with septicaemia), which is improved by the early administration of antibiotics.'-3 The infection is characteristically fulminant, with rapid clinical deterioration and death in a matter of hours-the mortality is particularly high in meningococcal septicaemia when there has been a delay in diagnosis or treatment (up to 60% when there is septic shock3). Therefore early recognition and aggressive management will improve the outcome in meningococcal disease. Nationally there has been an increasing trend in laboratory confirmed meningococcal disease over the 10 years from 1985 to 1995 (Public Health Laboratory Service meningococcal reference laboratory, personal communication; fig 1), although it is recognised that there is a consistent underreporting of survivors of meningococcal disease-perhaps because of failure to confirm the diagnosis bacteriologically.' The importance of this infection at a community and district general hospital level has prompted the development of a treatment algorithm for prehospital and hospital use, to encourage the early aggressive treatment of this disease. In this paper we review the current recommendations for the early management of meningococcal disease, and present them as a comprehensive quick reference algorithm for ambulance personnel, general practitioners, accident and emergency clinicians, and paediatricians.