12 Meningococcal disease

12.2 Clinical features

Table 12.1 below describes the symptoms and signs of meningococcal disease – individuals may present with some or all of these. Meningococcal bacteraemia is more common than meningitis and the illness may be non-specific or rapidly fatal.

Table 12.1: Symptoms and signs of meningococcal disease

Adolescents and adults Young infants and children
Sepsis syndrome




Rash – petechial or purpuric or maculopapular. A rash may not be present in the early stages of the disease and is absent in about one-third of cases

Sleepy, difficult to rouse

Arthralgia and myalgia

Occasionally in young adults, irrational behaviour
As for adolescents and adults, plus the following:
  • bulging fontanelle
  • tachycardia
  • altered responsiveness
  • irritability and/or floppiness
  • refusing drinks or feeds
  • ​poor peripheral perfusion
Notify all suspected cases as soon as possible to the local medical officer of health through your nearest public hospital. This includes out-of-hours notification.

Meningococcal disease covers a spectrum, from chronic septic arthritis and minor rash to fulminant sepsis and meningitis. Classic meningococcal sepsis is a form of gram-negative sepsis and frequently presents with sudden onset of fever and rash. Septic shock may rapidly ensue. Meningitis occurs when blood-borne organisms seed the meninges, and may be part of a sepsis syndrome, or present more with isolated signs of bacterial meningitis. In fulminant cases, disseminated intravascular coagulation, shock, coma and death can occur within a few hours despite appropriate treatment.

Because of the fulminant nature of meningococcal sepsis, antibiotics (Table 12.2) should be administered as soon as possible, often prior to transfer to hospital. Antibiotics given prior to transfer should be clearly noted on the clinical information that accompanies the patient to hospital.

Table 12.2: Recommended antibiotics for suspected cases

Antibiotic Dosage
Benzylpenicillin* Adults: 1.2 g (2 MU) IV (or IM) at least 6-hourly Children: 25–50 mg/kg IV (or IM) at least 6-hourly
Amoxycillin Adults: 1–2 g IV (or IM) Children 50–100 mg/kg IV (or IM)
* Patients with a documented history of anaphylaxis to penicillin and who are suspected of suffering from meningococcal disease should be sent immediately to hospital without pre-admission antibiotics.

Asymptomatic colonisation of the upper respiratory tract by N. meningitidis occurs in more than 10 percent of individuals and may be higher during epidemics and in household contacts of an index case. Smoking, passive smoking, crowding and upper respiratory tract infections increase carriage.

Most infection occurs in healthy people, but those with a deficiency of terminal components of complement (C5–9), properdin deficiency or asplenia are at particular risk of recurrent meningococcal disease. Individuals with infection caused by an uncommon serogroup or recurrent disease should be investigated.