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