Risk Stratification

Meningococcal disease may present with a clinical spectrum ranging from acute meningitis to rapidly progressive meningococcal septicaemia. Patients presenting with septic shock without meningitis carry the worst prognosis [22,23]. Although a few patients with meningitis will die from raised ICP, most deaths from meningococcal disease result from shock and multi-organ failure [24]. Meningococcal meningitis carries a lower risk of adverse neurological outcome than meningitis due to other bacteria.

Poor prognostic factors at presentation include [25-27]:

  • Admission between 0700 and 1100
  • Presence of shock
  • Absence of meningism
  • Rapidly progressive purpuric rash (> 50 petechiae)
  • Low peripheral WCC
  • Thrombocytopaenia
  • Markedly deranged coagulation
  • Depressed conscious level
  • Acidosis
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