🚨 Meningococcal Disease

Meningococcal disease is a life-threatening bacterial infection, most commonly caused by Neisseria meningitidis, presenting as meningitis, septicaemia, or both. Rapid recognition and treatment are crucial to prevent severe morbidity and mortality, especially in children and young adults. It is a notifiable disease in the UK.

Key features include sudden onset fever, headache, neck stiffness, photophobia, and a non-blanching purpuric rash (petechiae or purpura). Other signs may include vomiting, altered mental status, leg pain, and cold extremities. In infants, look for irritability, poor feeding, lethargy, and a bulging fontanelle.

A: Assess airway for patency; protect if GCS is low. B: Assess breathing for respiratory rate, oxygen saturation, and signs of respiratory distress. C: Assess circulation for heart rate, blood pressure, capillary refill time, and signs of shock. D: Assess disability using GCS, pupil response, and look for focal neurological deficits. E: Expose fully to identify rash, assess temperature, and look for other signs of infection.

Rapidly spreading or extensive purpuric rash, signs of septic shock (hypotension, prolonged capillary refill, cold peripheries), decreasing GCS, seizures, and respiratory compromise are critical red flags. These indicate severe disease and imminent organ failure. Persistent fever despite initial treatment is also concerning.

Bedside: Blood glucose, urine dipstick, vital signs monitoring. Bloods: Full blood count, C-reactive protein, electrolytes, renal function, liver function tests, coagulation screen, blood cultures, meningococcal PCR. Imaging: CT head before lumbar puncture if signs of raised intracranial pressure or focal neurology. Lumbar puncture: CSF for microscopy, culture, protein, glucose (contraindicated if signs of raised ICP).

Administer high-flow oxygen to maintain saturations. Establish intravenous access and give rapid fluid resuscitation for shock. Administer empirical broad-spectrum intravenous antibiotics immediately, ideally before lumbar puncture. Consider corticosteroids if meningitis is confirmed. Monitor vital signs closely and manage complications such as seizures or coagulopathy.

Any suspicion of meningococcal disease warrants immediate senior medical review. Deterioration in GCS, signs of shock, respiratory failure, or widespread purpura necessitate urgent critical care involvement. Inform public health authorities due to its notifiable status.

The classic non-blanching rash is a late sign; do not wait for it to appear before considering the diagnosis. Lumbar puncture is contraindicated if there are signs of raised ICP (e.g., GCS <12, focal neurology, papilloedema). Prophylaxis for close contacts is important. Remember the 'glass test' for the rash.