This unfortunate 27 year old pregnant woman collapsed at home with a seizure and then died soon after.  She had a disseminated W135 serotype infection – this serotype has been associated with a number of recent severe cases in Hunter New England.  Neisseria meningitidis case presentation Dr Rexson Tse May 2016

Perhaps there were no preventable features in this case, however useful to remember some key issues:

• acute meningococcal sepsis may cause death in the absence of a rash- the rash takes at least 12 hours to appear and it often has a blanching maculo-papular appearance at first
• conversely, an acute febrile illness that presents with a rash that has appeared in the first 2 days should lead to a suspicion of bacterial sepsis as viral exanthems will generally appear later in the illness – eg 4-5 days +
• in dark skinned individuals, always check the conjunctiva and oropharynx for evidence of petechial changes
• benzylpenicillin IV remains the drug of choice for rapid empiric therapy once the diagnosis is suspected; the diagnosis is not impeded by treating the patient prior to arrival in hospital – blood PCR for N. meningitidis is a highly sensitive and specific test even after antibiotics have been given.
•  abnormalities in CRP and procalcitonin take at least 8-12 hrs appear after the onset of sepsis

References

• Meningococcal-A3-InfoPoster-phcs-cdcb-Nov2012 : excellent summary poster for EDs from SA Health
• South Australian Health Meningococcal infection – including symptoms, treatment and prevention