title: Delayed recognition of fatal invasive meningococcal disease in adults.
abstract: BACKGROUND
  Invasive meningococcal disease can be difficult to detect early in its course when patients may appear well and the severity of their illness is obscured by non-specific complaints.
  
  
  METHODS
  We report five cases of meningococcal sepsis in adult patients who presented to an emergency department early in the course of their disease, but whose severity of illness was not recognized.
  
  
  CONCLUSIONS
  Suspicion of meningococcal sepsis should be heightened in the setting of hypotension, tachycardia, elevated shock index, leukopaenia with left shift, thrombocytopaenia and hypokalaemia, prompting early sepsis care.
authors.affiliation: Department of Emergency Medicine, North Central Bronx Hospital, Albert Einstein College of Medicine , Bronx, NY , United States.
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Nagel
authors.affiliation: New York City Department of Health and Mental Hygiene , New York, NY , United States.
authors.forename: Ifeoma
authors.initials: I
authors.lastname: Ezeoke
authors.affiliation: New York City Department of Health and Mental Hygiene , New York, NY , United States.
authors.forename: Mike
authors.initials: M
authors.lastname: Antwi
authors.affiliation: New York City Department of Health and Mental Hygiene , New York, NY , United States.
authors.forename: Paula E
authors.initials: PE
authors.lastname: Del Rosso
authors.affiliation: New York City Department of Health and Mental Hygiene , New York, NY , United States.
authors.forename: Marie
authors.initials: M
authors.lastname: Dorsinville
authors.affiliation: New York City Department of Health and Mental Hygiene , New York, NY , United States.
authors.forename: Beth M
authors.initials: BM
authors.lastname: Isaac
authors.affiliation: New York City Department of Health and Mental Hygiene , New York, NY , United States.
authors.forename: Althea
authors.initials: A
authors.lastname: Hayden
authors.affiliation: Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine , NY , USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.affiliation: Division of Emergency Critical Care, Stony Brook Hospital , Stony Brook, NY , USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Weingart
authors.affiliation: New York City Department of Health and Mental Hygiene , New York, NY , United States.
authors.forename: Don
authors.initials: D
authors.lastname: Weiss
keywords: Meningococcal Infections/complications; Meningococcal Infections/prevention & control; Neisseria meningitidis; New York City/epidemiology; Risk Factors; United States/epidemiol