The changing presentations of meningococcal disease.

UNLABELLED: Meningococcal disease (MCD) can present as meningitis, meningitis plus septicaemia or septicaemia alone. This 17-year retrospective study sought to determine if the proportion of cases presenting as septicaemia alone was increasing. Four hundred and forty-nine children with MCD were admitted between 1977 and 1993, 50 children died (11%). The proportion of cases with septicaemia alone increased from 7% in 1977-1985 to 36% in 1990-1993 (P < 0.0005). Mortality was highest in children with septicaemia alone (19%). Despite the increase in septicaemia, overall mortality did not alter over the 17 years.

CONCLUSION: MCD should not be thought of as "meningitis", since 33% of cases now present as septicaemia alone. Nearly one in five children with septicaemia alone die. Information and publicity about MCD should focus on septicaemia, characterised by a petechial rash, as the life-threatening presentation.