Meningococcal disease or meningitis is an infection of the fluid that surrounds the brain and spinal cord. It can occur quite suddenly, worsen rapidly, and often causes significant illness. It can also lead to death. In fact, meningococcal disease is the most common cause of infectious death in children, with a death rate of 5% to 15%.

Early diagnosis is essential, because the disease can progress to life-threatening in a matter of hours. The symptoms most often associated with meningococcal disease—stiff neck, rash, sensitivity to light, and unconsciousness—usually do not occur until about 12 hours after the disease’s onset. A child with meningococcal disease can be close to death within 24 hours. Identifying signs or symptoms that occur earlier than those listed above could save lives. A study published online in the January 11, 2006 issue of The Lancet found that there are signs common to children with meningococcal disease that occur earlier.

About the Study

The study included 448 children, aged 16 and younger, who had meningococcal disease. Of this group, 103 died and 345 survived. The researchers interviewed parents and the patients’ general practitioners and used medical records to identify what the initial symptoms were and at what time they developed. They also recorded any additional symptoms and their time of appearance.

The researchers found that the disease progressed rapidly in most children. Fever was the first symptoms noticed in children younger than five; headache was the first symptom noticed in children older than five. Other symptoms not specific to meningococcal disease—nausea, vomiting, loss of appetite, and sore throat—occurred within the first eight hours as well. However, the first specific clinical signs for meningococcal disease were of sepsis (severe, widespread infection) and shock. These clinical features were leg pain, cold hands and feet, and abnormal skin color. They generally occurred within the first 12 hours of disease onset. The classic symptoms like rash and unconsciousness were noticed anywhere from 13-22 hours after disease onset.

These results are interesting, but there are limitations to this study. The researchers collected the data several months after the fact. Although the interviewed parents felt they remembered the events well, their recall may have been biased to the more classic symptoms of meningococcal disease, or they simply may not have remembered other non-specific symptoms. Also, the study did not look at children with other illnesses to compare symptom similarities or frequency.

How Does This Affect You?

If your child complains of a headache, has a fever, or experiences nausea and vomiting, should you immediately suspect meningococcal disease? It is highly unlikely that meningococcal disease is the cause. Fortunately, severe meningitis is a rare disease. But, it can rarely be ruled out within the first four to six hours. Knowing these additional signs—leg pain, cold hands and feet, and abnormal skin color—can help you assess the seriousness of your child’s condition. The study’s authors suggest that should you receive assurance from your child’s doctor that the condition is not meningococcal disease, make sure you can easily re-consult him or her if your child’s condition worsens, especially if these additional signs develop.

Educating health professionals and parents of these additional clinical features is of critical importance so that the disease can be recognized as early as possible and the appropriate treatment can be started without delay.