Systemic meningococcal disease: the diagnosis on admission to hospital.

The clinical and laboratory findings in 176 patients hospitalized with suspected systemic meningococcal disease (MCd) are presented. All except nine patients were prospectively included in the MenOPP study. One hundred and fifteen patients were most likely to have meningococcal disease, of these 71 were confirmed with growth of meningococci in blood and/or cerebrospinal fluid (CSF). The remaining sixty-one patients served as the control group. Both petechiae, reduced general condition, and reduced consciousness proved valuable in the diagnosis of MCd. Petechiae was the clinical sign best discriminating between MCd and the control group. Ecchymoses were specific for meningococcal disease. Among the laboratory tests C-reactive protein (CRP) and Thrombotest (TT) were the tests which most frequently were found to be abnormal in patients with meningococcal disease. A diagnostic score is computed by the aid of a multiple regression analysis. This score includes the variables skin hemorrhages, body pain, CSF cell count, TT, CRP and white blood cell count. For a patient hospitalized with suspected MCd a score of three or more supports the diagnosis and should indicate the need for rapid antibiotic therapy.