The changing presentations of meningococcal disease.
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.
Riordan
F A
FA
Institute of Child Health, Alder Hey Children's Hospital, Liverpool, UK.
Marzouk
O
O
Thomson
A P
AP
Sills
J A
JA
Hart
C A
CA
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