Prognosis of meningococcal disease

It is important to recognise the patients who will progress from a non specific early presentation to severe disease since failure to initiate treatment rapidly will be fatal with the majority of deaths occurring in the first 24 hours (before specialist intervention) (1).

In early childhood, meningococcal disease is the leading infectious cause of death

• it can be fatal within hours of the first symptoms appearing
• the case fatality rate is about 10% (2)

The worst prognosis is said to be in patients who present with septic shock without meningitis (3).

Death in few people (with meningitis) is caused by raised intracranial pressure but the majority of deaths in meningococcal disease are due to shock or multi organ failure (3)

• meningococcal septicaemia may progress rapidly to shock and circulatory collapse and the deterioration can be irreversible (4)

Features which predict poor prognosis at the time of presentation:

• presence of shock
• absence of meningism
• rapidly progressive purpuric rash
• low peripheral white blood cell count
• thrombocytopenia
• markedly deranged coagulation
• depressed conscious level (3)

Reference:

• 1. Scottish Intercollegiate Guidelines Network (SIGN) 2008. Management of invasive meningococcal disease in children and young people. A national clinical guideline
• 2. Visintin C et al. Management of bacterial meningitis and meningococcal septicaemia in children and young people: summary of NICE guidance. BMJ. 2010;340:c3209
• 3. Meningitis Research Foundation 2010. Lessons from research for doctors in training
• 4. Meningitis Research Foundation 2008. Meningococcal septicaemia. Identification & management for ambulance personnel. 2nd edition