Meningococcal disease and meningitis: a review of deaths proceeding to coroner directed autopsy in Auckland.
OBJECTIVE
To assist the early diagnosis of meningitis, by finding trends and patient profiles, where delay or other factors may have lead to a fatal outcome.


METHODS
All deaths from meningitis and meningococcal disease, confirmed at autopsy were reviewed. The study involved the Auckland area, in the period January 1988 November 1997.


RESULTS
Cases were divided into those caused by N meningitidis and other meningitides. Death due to N meningitidis is often within 12-24 hours of the first symptomatology. Symptoms are often vague and may be indistinguishable from any other infection, often leading to fatal patient or doctor delay. A diagnosis of meningococcal disease cannot be excluded on: no rash (44%), no "meningitis" symptoms as sepsis without meningitis occurs (44%), age (50% were over 15 years old) or the presence of other abnormalities, eg bronchopneumonia or hydrocephalus. Non-N meningitidis menigitis is a disease of the very young or old, its time course is also swift with 30% suffering similar vague symptoms for less than 24 hours before death.


CONCLUSIONS
For both categories, treat immediately and treat on suspicion, otherwise conformation of the diagnosis might be postmortem.
John
S M
SM
Department of Pathology, Faculty of Medicine and Health Science, University of Auckland.
Koelmeyer
T D
TD
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001344:Autopsy / Q000706:statistics & numerical data*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003334:Coroners and Medical Examiners / Q000706:statistics & numerical data*; D005006:Ethnicity; D017809:Fatal Outcome; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008585:Meningitis, Meningococcal / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D008589:Meningococcal Infections / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012307:Risk Factors; D013997:Time Factors; D014504:Urban Health