Meningococcal Disease & Bacterial Meningitis - ED revision
This section summarises recognition, pathophysiology, immediate assessment and time‑critical management of invasive meningococcal disease (IMD) and bacterial meningitis in the emergency department.
It emphasises early recognition, sepsis resuscitation, urgent empirical treatment and the public‑health responsibilities required in suspected IMD. Recommendations are aligned with current UK guidance (NICE NG240, UKHSA clinical/public‑health guidance, Resuscitation Council UK).
Why this matters
- IMD and bacterial meningitis remain leading infectious causes of death and serious morbidity in infants, children and young adults.
- Presentations range from subtle, viral‑like symptoms to fulminant septicaemia; deterioration can be extremely rapid.
- Early recognition, immediate resuscitation and prompt empiric antibiotics are lifesaving - delays are frequently associated with poor outcomes.
Epidemiology, organisms and vaccination context
- Causative organisms vary by age:
- Neonates (≤28 days): Group B Streptococcus, Escherichia coli, Listeria monocytogenes, Streptococcus pneumoniae.
- Infants/children (>3 months): Neisseria meningitidis, Streptococcus pneumoniae, (historically Haemophilus influenzae type b where unvaccinated).
- Adults/elderly: Neisseria meningitidis and Streptococcus pneumoniae; Listeria risk rises in the elderly and immunocompromised.
- Neisseria meningitidis is a gram‑negative diplococcus with multiple capsular groups (B, C, W, Y are most important in the UK).
- Carriage of N. meningitidis is common (higher in adolescents); transmission occurs via respiratory droplets and close contact.