Meningococcal Disease Children

Background

There are 5 common meningococcal serogroups – A,B,C,W,Y.

In January 2019, the HPSC issued an alert regarding W cases: some of whom presented with septicaemia and gastrointestinal symptoms (abdominal pain, vomiting and diarrhoea). No rash was evident at the time of presentation. These cases were critically unwell with a poor prognosis.

Clinical

History

Headache/Photophobia
Neck & back stiffness
Vomiting/off feeds
Lethargy/altered conc
Irritability (infant)
Fever
Rash (meningococcal)

Classic clinical features of meningococcal disease can appear relatively late in the illness, early clinical features include:

Leg pains
Cold hands & feet
Abnormal skin colour

Examination

Ensure Airway is clear, breathing pattern ok
Circulation pulse rate & vol, BP, cap. refill
Pyrexia
Skin Changes / Rash (meningococcal)
Meningism
Bulging Fontanelle
↓ Level Conc
Signs of ↑ICP:
- Fluctuating level of conc
- ↑BP & relative bradycardia
- Pupils unequal or focal neurology
- Seizures or Posturing
- Papilloedema (late)

Suspect Sepsis if

Tachycardia, low volume pulse
Capillary refill (>3 sec)
Skin to core temp difference
Evolving rash
Oliguria (<1ml/kg/hr)
Hypotension (late sign)

Suspect Cerebral Oedema

Na⁺<135mmol/L & signs of ↑ICP
or
Na⁺<130mmol/l without clinical signs

Beware

Bad Prognostic Signs

Differential skin/core temp > 3O°C (children)
SBP < 85 mm Hg (age > 4yrs)
SBP < 75 mm Hg (age < 4yrs)
WCC <10.0 x10⁹/L
Meetab. ↓pH (BE > -5.0 mmol/l or Lactate climbing)
Coagulopathy
Rapidly evolving characteristic rash
Glasgow meningococcal prognostic score (GMPS) > 8

Algorithm

Pre-hospital Antibiotics

The doses of benzylpenicillin (ideally IV but can give IM, although may not be as effective) for GP use in suspected meningococcal infection are tabled:

Adults & children > 10 yrs	1200 mgs
Children 1 - 9 yrs	600 mgs
Children < 1 yr	300 mgs

Meningococcal Disease in Children