Thompson MJ et al. (2006) Clinical recognition of meningococcal disease in children and adolescents. Lancet 367: 397–403

Meningococcal disease progresses rapidly; early diagnosis and treatment is therefore very important. As early symptoms of this disease can be difficult to distinguish from those of common self-limiting infections, however, many children are initially misdiagnosed. To improve understanding of the early signs of this devastating disease, researchers in the UK investigated the pre-hospital sequence of its symptoms in children.

Questionnaires and interviews were used to collect data from parents of 448 children aged ≤16 years who had had meningococcal disease between December 1997 and February 1999 (103 fatal, 345 nonfatal cases).

Median time between onset (first symptoms) and hospital admission was 13 h in children under 1 year of age, increasing with age to up to 22 h in those aged15–16 years. Fever was the first symptom in children aged <5 years; those aged ≥5 years experienced headache first. All age-groups showed early symptoms common to many viral illnesses, such as loss of appetite, irritability, nausea and vomiting; these symptoms generally occurred 4–8 h from onset. The first specific clinical features of meningococcal disease were signs of sepsis (leg pain, cold hands and feet, abnormal skin colour), which generally occurred within 12 h of onset. Classic meningitis symptoms (e.g. rash, neck stiffness, photophobia) occurred later, around 12–15 h from onset, followed by unconsciousness, delerium and seizures at 16–22 h.

The authors conclude that leg pain, cold hands and feet, and abnormal skin colour are also important clinical signs of meningococcal disease in children ≤16 years. They urge that these early signs are recognized by both parents and primary-care clinicians, as the widely recognized, classic symptoms only occur later in the disease course, thereby delaying vital early hospital treatment.