Lesson of the Week: Who spots the spots? Diagnosis and treatment of early meningococcal disease in children

Update on Meningococcal Disease with Emphasis on Pathogenesis and Clinical Management

“…This requires not only medical acumen and expertise but also permanent vigilance by a wellinformed public (179,180,388). Unfortunately, the latter is not the case.…”

“…Early diagnosis of meningococcemia is extremely difficult and requires a high degree of suspicion (179,180,388). Typically, a completely healthy child complains of myalgia of sudden onset, chills, and fever (296).…”

Microbiological epidemiological history of meningococcal disease in Rio de Janeiro, Brazil

“…20,22,32,33 This is the result of several factors, highlighting immediate administration of antibiotic therapy, 33 the recognition and treatment of patients who may have complications, 34 the establishment of specialized mobile intensive care teams, 35 centralization of care of seriously ill patients in an intensive care unit (ICU), 32 and dissemination of guidance about early recognition and management. 36,37 Clinical presentation of meningococcal disease in 2338 patients studied in the city of Rio de Janeiro demonstrated the importance of hemorrhagic rash, a clinical manifestation of sepsis and the fi rst classic symptom of meningococcal disease to spring. The serogroup C epidemic in Rio de Janeiro was accompanied both by an excess of patients with a suggestive rash and an increase of cases diagnosed as sepsis alone, an indication of the spread of a hipervirulent strain when the "force of infection" was high.…”

Infections in children

“…These leaflets do not emphasise the rash, a specific feature which is first recognised by most parents [135]. However, those attempts at dissemination of information have largely been overtaken …”