Meningococcal meningitis in patients with falciparum malaria.

Between October 1994 and January 1995 a field hospital saw nine cases of falciparum malaria associated with meningococcal meningitis among Rwandan patients residing in Kibumba refugee camp in Goma, Zaire. All except one presented with signs and symptoms suggestive of meningeal irritation; all but one responded to intravenous quinine and chloramphenicol or ampicillin. Two had recrudescence of malaria and responded to treatment with pyrimethamine-sulphadoxine (Fansidar). There were no sequelae seen. Meningococcal meningitis is uncommon but frequently fatal if it occurs in patients with falciparum malaria. Early diagnosis and treatment are urgent to decrease morbidity and mortality.