THE CHANGING PRESENTATIONS OF MENINGOCOCCAL DISEASE

Meningococcal disease (MCD) can present as meningitis, meningitis plus septicaemia or septicaemia alone. This 17-year retrospective study so ught to determine if the proportion of cases presenting as septicaemia alone was increasing. Four hundred and forty-nine children with MCD w ere admitted between 1977 and 1993, 50 children died (11%). The propor tion of cases with septicaemia alone increased from 7% in 1977-1985 to 36% in 1990-1993 (P < 0.0005). Mortality was highest in children with septicaemia alone (19%). Despite the increase in septicaemia, overall mortality did not alter over the 17 years. Conclusion MCD should not be thought of as ''meningitis'', since 33% of cases now present as sep ticaemia alone. Nearly one in five children with septicaemia alone die . Information and publicity about MC-D should focus on septicaemia, ch aracterised by a petechial rash, as the life-threatening presentation.