Meningococcal Disease in 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 is ok
  • Circulation pulse rate & vol, BP, capillary refill
  • Pyrexia
  • Skin Changes
  • Rash (meningococcal)
  • Meningism
  • Bulging Fontanelle
  • Decreased Level Conc
  • Signs of raised ICP:
    • Fluctuating level of conc
    • ↑BP & relative bradycardia
    • Pupils unequal
    • 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 raised ICP (see column to left)
    or
  • Na<130mmol/l without clinical signs

Beware

Bad Prognostic Signs

  • Differential skin/core temp > 3OC (children)
  • SBP < 85 mm Hg (age > 4yrs)
  • Systolic BP < 75 mm Hg (age < 4yrs)
  • WCC <10.0 x109/L
  • Metabolic acidosis
    • BE > -5.0 mmol/l
      or
    • Lactate > 5
      or
    • Lactate rising
    • Coagulopathy
    • Rapidly evolving characteristic rash
    • Glasgow meningococcal prognostic score (GMPS) > 8

Algorithm

Meningococcal DiseaseFlow Diagram small

Adults & children > 10 yrs1200 mgs
Children 1 - 9 yrs600 mgs
Children < 1 yr300 mgs

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:



Content by Dr Ronán O' Sullivan (OLHSC), Dr Íomhar O' Sullivan 06/6/2005. Reviewed by Dr ÍOS 12/07/2007, 05/12/2008. Last review Dr ÍOS 16/06/21