Lesson of the Week: Who spots the spots? Diagnosis and treatment of early meningococcal disease in children

doi:10.1136/bmj.313.7067.1255

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F Andrew I Riordan, research fellowa,
Alistair P J Thomson, honorary consultant paediatriciana,
John A Sills, consultant paediatriciana,
C Anthony Hart, professor of medical microbiologyb

^a Institute of Child Health, University of Liverpool, Liverpool L69 3BX
^b Department of Medical Microbiology

Correspondence to: Dr F A I Riordan, Undergraduate Teaching Centre, Birmingham Heartlands Hospital, Birmingham B9 5SS.

Accepted 20 August 1996

Meningococcal disease can begin suddenly and may kill within hours.1 Delays in diagnosis and treatment can therefore decrease the chances of survival. The commonest delays in those who die are: parents not recognising that their child is seriously ill; and doctors failing to make a correct diagnosis.2

Information for parents and doctors about meningococcal disease should emphasise the septicaemic rash, not meningitis

Accurate information about meningococcal disease for both parents and doctors is therefore extremely important. The information widely available, however, may be misleading, because it tends to focus on meningitis rather than on septicaemia.3 More deaths result from septicaemia, and the proportion of children who present with septicaemia is increasing.4

We conducted a prospective study of children admitted with meningococcal disease over a period of 18 months, and we highlight the details of one case in which a missed diagnosis led to the child's death.

Subjects and methods

This prospective study included all children admitted with meningococcal disease over 18 months to four hospitals in Merseyside: Alder Hey Children's Hospital, Arrowe Park, Whiston Hospital, and the Countess of Chester Hospital. Parents were interviewed on admission and were asked about specific features they had noticed, their reasons for seeking medical advice, and the outcome of any contact with a doctor during the illness.

Results

One hundred and twenty six children with meningococcal disease were admitted, 13 of whom died. Neisseria meningitidis was isolated from 78 cases. The median age (range) was 20 months (3 months to 14 years). On admission 113 children had a …