Meningococcal disease — Rapid | Doctor’s Passport

Synopsis

Recognise invasive meningococcal infection before the full rash or meningism develops, treat septic and meningeal phenotypes without delay, investigate safely, and coordinate complications, follow-up and public-health protection.

Meningococcal disease means invasive Neisseria meningitidis infection, presenting as bloodstream infection, meningitis or both; deterioration can occur over hours.
Early clues include fever, vomiting, severe limb pain, cold extremities, altered behaviour, tachypnoea and poor perfusion. Do not wait for purpura or meningism.
Inspect the whole skin in good light, including conjunctivae, oral mucosa, palms and soles. Test blanching, palpate lesions and repeat the examination because rash evolves.
Transfer every suspected case to hospital as an emergency and inform the receiving team that senior assessment and immediate treatment will be required.
Outside hospital, do not delay transfer simply to give antibiotics. When meningococcal disease is strongly suspected, give intramuscular or intravenous ceftriaxone or benzylpenicillin as soon as possible if transfer is not delayed.
In hospital, first-line treatment for suspected or confirmed meningococcal disease is intravenous ceftriaxone within 1 hour of arrival, alongside sepsis resuscitation.
Take blood culture, full blood count, C-reactive protein or procalcitonin, glucose, lactate, renal, liver and coagulation tests, plus whole-blood meningococcal and pneumococcal PCR, without delaying antibiotics.
Lumbar puncture is the reference diagnostic procedure for meningitis when safe. Stabilise airway, breathing, shock, uncontrolled seizure and bleeding risk first; most patients do not need neuroimaging before it.
Do not perform lumbar puncture with extensive rapidly spreading purpura, local skin infection, an evolving intracranial mass risk or signs of brain herniation.
For confirmed meningococcal infection, stop ceftriaxone after 5 days if recovered; obtain infection-specialist advice if recovery is incomplete or the diagnosis and organism remain uncertain.
Do not routinely give corticosteroids for meningococcal disease. Dexamethasone belongs to the strongly suspected bacterial-meningitis pathway over 3 months and is stopped if meningococcus is identified.
Notify the health protection team urgently. UKHSA determines close contacts needing chemoprophylaxis and any indicated vaccination; clinicians should not improvise a contact list or delay referral.

Key red flags

A rapidly evolving non-blanching petechial or purpuric rash with fever or toxic appearance is meningococcal disease until an emergency assessment establishes otherwise.

Severe limb or muscle pain, cold hands and feet, pallor or mottling, prolonged capillary refill and reduced urine output can precede the characteristic rash.

Confusion, unusual drowsiness, irritability, high-pitched cry, bulging fontanelle, neck stiffness, photophobia, focal seizure or reduced consciousness suggests meningeal or cerebral involvement.

Apnoea, grunting, hypoxaemia, weak pulses, hypotension, metabolic acidosis or rising lactate indicates advanced physiological compromise and need for paediatric intensive care.

Absence of rash does not exclude meningococcal meningitis or early septicaemia, and rash may be less visible on brown or black skin.

Extensive or rapidly spreading purpura is a contraindication to lumbar puncture during the unstable phase; obtain blood diagnostics and treat immediately.

Investigation priorities

First-line: blood culture and whole-blood PCRFirst stepFirst line

Identify meningococcus and preserve diagnostic yield before or after antibiotics.

First-line: sepsis blood panelFirst line

Assess inflammation, perfusion, organ injury and disseminated coagulation.

Management branches

Pre-hospitalTransfer and treat without delay

Meningococcal disease or bacterial meningitis is suspected outside hospital.

Arrange emergency transfer and tell the receiving hospital that urgent senior assessment is required.
Do not delay departure to give antibiotics; when meningococcal disease is strongly suspected, give ceftriaxone or benzylpenicillin if this does not delay transfer.
Continue airway, breathing and circulation support and communicate the drug, route, dose and exact time at handover.

Key medicines

CeftriaxoneGive intravenously at the highest current BNFC meningitis dose; for post-newborn community-acquired sepsis NICE specifies 80 mg/kg once daily, maximum 4 g. If meningococcus is confirmed, stop after 5 days when recovered.Use the neonatal pathway for young babies and cefotaxime when ceftriaxone is contraindicated. Check severe beta-lactam allergy and never mix with calcium-containing intravenous solutions; obtain infection advice for severe allergy.

Benzylpenicillin or ceftriaxone before hospitalGive the current BNFC age-and-weight intramuscular or intravenous emergency dose for strongly suspected meningococcal disease only when administration will not delay emergency transfer.Do not delay transport to establish access or complete dosing. Do not give outside hospital with severe allergy to both agents; record exact drug, dose, route and time.

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