Meningococcal disease is an acute contagious life-threatening illness, characterised by fever, petechial or purpuric rash, and signs of sepsis and/or meningitis. It is a notifiable disease in the UK.
May progress rapidly to septic shock, with hypotension, acidosis, and disseminated intravascular coagulation.
Highest rates of invasive infection are in children under 5 years of age, especially under 1 year of age, with a second peak occurring in 11- to 22-year-olds, and third peak in people >65 years of age.
Diagnosis is confirmed by isolation of Neisseria meningitidis from a normally sterile body site.
Confirmed meningococcal infection is treated with a third-generation cephalosporin. Where a cephalosporin is not appropriate, the choice of agent is based on the individual patient circumstances, antibiotic susceptibilities, and local availability.
Meningococcal infections are caused by Neisseria meningitidis, a gram-negative diplococcus that colonises the nasopharynx. Bacteria invade the bloodstream or spread within the respiratory tract. A case is confirmed by detection of N meningitidis-specific nucleic acid (using a validated polymerase chain reaction assay) in a specimen obtained from a normally sterile site (e.g., blood or cerebrospinal fluid), or by isolation of N meningitidis from a normally sterile site. Probable cases include those where N meningitidis antigen is detected by immunohistochemical staining on formalin-fixed tissue, or in cerebrospinal fluid by latex agglutination.
This topic covers meningococcal disease (meningococcal meningitis and/or meningococcal sepsis) and bacterial meningitis in non-pregnant adults and children. See also our topic Bacterial meningitis in adults.
History and exam
Key diagnostic factors
- stiff neck
- rapid deterioration
- altered mental state
- unusual skin colour
- aching legs
- cold peripheries
- back rigidity
- bulging fontanelle
- Kernig’s sign
- Brudzinksi’s sign
- toxic/moribund state
- focal neurological deficit including cranial nerve involvement and abnormal pupils
- presence of risk factors
Other diagnostic factors
- ill appearance
- refusing food/drink
- muscle ache/joint pain
- respiratory distress or breathing difficulty
- diarrhoea, abdominal pain/distension
- sore throat/coryza or other ear, nose, and throat symptoms/signs
- young age
- complement deficiency
- use of eculizumab and ravulizumab
- immunoglobulin deficiency
- asplenia or hyposplenia
- university attendance
- close contact with invasive meningococcal infection
- household crowding
- travel to a hyperendemic or epidemic area
- laboratory workers
- recent move into a new community
- tobacco smoke exposure
- respiratory infection
- visiting bars/clubs
1st investigations to order
- blood gases
- blood cultures
- full blood count
- urea, electrolytes and creatinine, Ca2+, Mg2+, PO4-
- coagulation profile
- procalcitonin (or CRP)
- liver function
- cross-match (children)
- PCR for Neisseria meningitidis
- CFS PCR for Neisseria meningitidis and Streptococcus pneumoniae
- PCR for Streptococcus pneumoniae (adults)
- CSF white blood cell count and examination
- CSF total protein concentration
- CSF glucose concentration
- CSF microscopy, Gram stain, culture and sensitivities
- CSF lactate (adults)
- throat swab for culture
Investigations to consider
- cranial CT
- complement deficiency (children)
- serum HIV (adults)
suspected bacterial meningitis: presenting in hospital
suspected meningococcal sepsis: presenting in hospital
suspected meningococcal disease (meningitis or sepsis): presenting in the community
confirmed or probable bacterial meningitis (including meningococcal meningitis)
confirmed or probable meningococcal disease
Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Greater Sydney Area
Helicopter Emergency Medical Service
New South Wales
AA declares that he has no competing interests.
BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:
Elisabeth Adderson, MD
St. Jude Children's Research Hospital
Associate Professor of Pediatrics
University of Tennessee Health Sciences Center
EA declares that she has no competing interests.
Robert Taylor, MBChB, MRCP(UK), MRCP(London), DipMedTox, DipTher PGDME, FHEA FRCEM
Acute Hospital Sub Dean (Cornwall)
Honorary Clinical Senior Lecturer
Consultant Emergency Physician
The Knowledge Spa
Royal Cornwall Hospital
RT declares that he has no competing interests.
Brian Angus, BSc, MBChB, DTM&H, FRCP, MD, FFTM
Consultant in Infectious Diseases
Clinical Tutor in Medicine and Associate Professor and Reader in Infectious Diseases
University of Oxford
Oxford Centre for Clinical Tropical Medicine and Global Health
BA declares that he has no competing interests.
Section Editor, BMJ Best Practice
SM works as a freelance medical journalist and editor, video editorial director and presenter, and communications trainer. In this capacity, she has been paid, and continues to be paid, by a wide range of organisations for providing these skills on a professional basis. These include: NHS organisations, including the National Institute for Health and Care Excellence, NHS Choices, NHS Kidney Care, and others; publishers and medical education companies, including the BMJ Group, the Lancet group, Medscape, and others; professional organisations, including the British Thoracic Oncology Group, the European Society for Medical Oncology, the National Confidential Enquiry into Patient Outcome and Death, and others; charities and patients’ organisations, including the Roy Castle Lung Cancer Foundation and others; pharmaceutical companies, including Bayer, Boehringer Ingelheim, Novartis, and others; and communications agencies, including Publicis, Red Healthcare and others. She has no stock options or shares in any pharmaceutical or healthcare companies; however, she invests in a personal pension, which may invest in these types of companies. She is managing director of Susan Mayor Limited, the company name under which she provides medical writing and communications services.
Lead Section Editor, BMJ Best Practice
TAO declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
AM declares that he has no competing interests.
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