Editorials

Optimising the investigation of meningococcal disease

The incidence of meningococcal disease in England and Wales has remained at high levels over the past two winters, as has the proportion of cases caused by strains of serogroup C (M Ramsay, E Kaczmarski, personal communications). Clusters, also caused mainly by serogroup C strains, have increased considerably, particularly among students at schools and universities (A Rushdy, J Stuart, personal communications). While effective vaccines are awaited, current priorities are to optimise recognition, diagnosis, and management.

Administration of benzylpenicillin to suspected cases before admission to hospital reduces mortality¹ and is advocated by the United Kingdom's chief medical officers. Though now used more widely, continuing failure to implement this simple measure² may be due to a misplaced fear of obscuring the diagnosis and thereby jeopardising management.

After an injection of benzylpenicillin blood culture is rarely positive and, though cerebrospinal fluid may still yield meningococci,³ lumbar puncture is an increasingly controversial investigation in . . . [Full text of this article]

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• Hahne, S. J M, Charlett, A., Purcell, B., Samuelsson, S., Camaroni, I., Ehrhard, I., Heuberger, S., Santamaria, M., Stuart, J. M (2006). Effectiveness of antibiotics given before admission in reducing mortality from meningococcal disease: systematic review.. BMJ 332: 1299-1303 [Abstract] [Full text]  
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• van Deuren, M., Brandtzaeg, P., van der Meer, J. W. M. (2000). Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management. Clin. Microbiol. Rev. 13: 144-166 [Abstract] [Full text]  
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• Kristiansen, B.-E., Tveten, Y., Jenkins, A. (1998). Which contacts of patients with meningococcal disease carry the pathogenic strain of Neisseria meningitidis? A population based study. BMJ 317: 621-625 [Abstract] [Full text]  
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• Barquet, N., Domingo, P., Cayla, J. A (1997). Prognostic Factors in Meningococcal Disease-Reply. JAMA 278: 1658-1659 [Abstract]