Expansion
A non-blanching rash in an unwell patient is meningococcal until proven otherwise
Expansion
Recognition
- Non-blanching petechial or purpuric rash, confirmed with the glass test. It may start as a blanching maculopapular rash, and may be absent early or hidden in dark skin, so look at the whole body including soles and conjunctivae
- Fever, and in septicaemia: cold hands and feet, leg pain, abnormal skin colour and prolonged capillary refill, which appear before the classic signs
- Meningitis features: headache, photophobia, neck stiffness, vomiting. In infants, a bulging fontanelle, high pitched cry, poor feeding and irritability
“Cold hands, leg pain and abnormal colour come before the rash and before the meningism.” Those three are the early signs in children and are the ones most often missed.
Immediate treatment
- Community: intramuscular or intravenous benzylpenicillin and immediate transfer
- Hospital: ceftriaxone, blood cultures, fluid resuscitation and critical care involvement. Do not delay antibiotics for a lumbar puncture
- Dexamethasone is given in suspected bacterial meningitis but not in meningococcal septicaemia
Waterhouse-Friderichsen syndrome is bilateral adrenal haemorrhage causing adrenal failure, and is a cause of refractory shock.
Public health: it is a notifiable disease, and close contacts need ciprofloxacin prophylaxis.