Meningococcal disease is the most common infectious cause of death in children in many developed countries. The disease can progress from initial symptoms to death within hours, so early diagnosis is crucial. However, the classic symptoms of the disease rash, headache, stiff neck, sensitivity to light, and impaired consciousness occur late in the pre-hospital illness and currently parents and doctors are over-reliant on these for diagnosis.

To investigate the early clinical features of the disease, Matthew Thompson (University of Oxford, UK) and colleagues sent questionnaires to parents of 448 children with meningococcal disease. They also looked at the children's medical records. They found that the classic symptoms of the disease developed late, with an average onset of 13-22 hours. By contrast, 72% of the children had early symptoms of infection (sepsis) leg pain, cold hands and feet, and abnormal skin colour - that developed at an average of 8 hours. These early clinical features should be promoted to parents and doctors to substantially speed up diagnosis of this potentially fatal infection in children, state the authors.

Dr Thompson states: "Recognising early symptoms of sepsis [infection] could increase the proportion of children identified by primary-care physicians and shorten the time to hospital admission. The framework within which meningococcal disease is diagnosed should be changed to emphasise identification of these early symptoms by parents and clinicians."

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Contact: Joe Santangelo
j.santangelo@elsevier.com
212-633-3810
Lancet
11-Jan-2006