Presenting features of paediatric meningococcal disease--a five year experience from a paediatric accident and emergency department.

OBJECTIVES

To determine the clinical features, initial management and outcome of meningococcal disease presenting to a paediatric accident and emergency (A&E) department.

DESIGN

A retrospective study of all cases of meningococcal disease seen in the department over a five year period.

SETTING

A paediatric A&E department which treats approximately 30,000 patients a year.

SUBJECTS

All children under the age of 13 years with a discharge diagnosis of meningococcal disease

RESULTS

Fifty patients, forty-six with microbiological confirmation of their diagnosis were identified. Sixty six percent of patients were seen first by their general practitioner. However only 28% had received prehospital parenteral antibiotics. Twenty six percent of children had neither meningism nor a classical purpuric rash, 60% showed signs of shock and 66% had an altered conscious level. The case fatality rate was 4%, with 78% making a full recovery.

CONCLUSION

Classical features of meningococcal disease are often absent. Assessing simple clinical parameters such as capillary refill, respiratory rate and conscious level adds to the detection of the disease. If meningococcal disease is suspected parental benzylpenicillin should be given and the child transferred to hospital.