Meningococcal Septicaemia and the Use of Benzyl Penicillin
Meningococcal disease is rare but potential killer both in adults and in children and one of its features is the rapidity with which it develops. There are two distinct types, though sometimes they may both be present. One is a form of meningitis (infection of the coverings of the brain), and the other is septicaemia (infection in the bloodstream and thus throughout the body). Meningococcal refers to the type of bacteria (the meningococcus) that produces the infection , not the region of the body affected.
Meningitis alone is the more common of the two types of meningococcal infection, and requires urgent but not immediate treatment. Meningococcal septicaemia on the other hand is a medical emergency and this is where the earliest administration of benzyl penicillin may save life and reduce morbidity. Both types of patient (and these can be adults as well as children) need to be taken to hospital with minimum delay, but it is the septicaemic patient who needs immediate benzyl penicillin en route. Note that paramedics are NOT authorised to give penicillin solely for meningococcal meningitis.
The patient with septicaemia is likely to develop shock and the characteristic purpuric rash and this is how the diagnosis may be made clinically. If the patient does not have the rash it is impossible to make the diagnosis with any certainty. These patients may deteriorate very rapidly. A leaflet provided by the Meningitis Research Foundation is shortly to be circulated to raise ambulance staff awareness of this rare but potentially very serious condition and to help them (possibly the first healthcare providers-on-scene) to identify the patient at risk and treat them appropriately.