title: The changing presentations of meningococcal disease.
abstract: Meningococcal disease (MCD) can present as meningitis, meningitis plus septicaemia or septicaemia alone. This 17-year retrospective study sought to determine if the proportion of cases presenting as septicaemia alone was increasing. Four hundred and forty-nine children with MCD were admitted between 1977 and 1993, 50 children died (11%). The proportion of cases with septicaemia alone increased from 7% in 1977-1985 to 36% in 1990-1993 (P < 0.0005). Mortality was highest in children with septicaemia alone (19%). Despite the increase in septicaemia, overall mortality did not alter over the 17 years.
  
  
  CONCLUSIONS
  MCD should not be thought of as "meningitis", since 33% of cases now present as septicaemia alone. Nearly one in five children with septicaemia alone die. Information and publicity about MCD should focus on septicaemia, characterised by a petechial rash, as the life-threatening presentation.
authors.affiliation: Institute of Child Health, Alder Hey Children's Hospital, Liverpool, UK.
authors.forename: F A
authors.initials: FA
authors.lastname: Riordan
authors.forename: O
authors.initials: O
authors.lastname: Marzouk
authors.forename: A P
authors.initials: AP
authors.lastname: Thomson
authors.forename: J A
authors.initials: JA
authors.lastname: Sills
authors.forename: C A
authors.initials: CA
authors.lastname: Hart
mesh_terms: D016470:Bacteremia / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D016009:Chi-Square Distribution; D004739:England / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008585:Meningitis, Meningococcal / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D008589:Meningococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D012189:Retrospective Studies; D012720:Severity of Illness Index