Diagnosing meningococcemia as a cause of sepsis.

OBJECTIVE: In 2004, a consensus meeting of critical care and infectious disease experts was organized to review and make recommendations on current definitions of infections, sepsis, and organ failure for neonates and children and for the predisposing conditions leading to these diseases. Among the infections leading to sepsis, meningococcemia is so distinguishable that a separate article on its diagnosis and management was thought to be warranted. DESIGN AND METHODS: The process included a modified Delphi method, a consensus conference, subsequent smaller meetings of subgroups and key individuals, and electronic-based discussion among subgroups. A systematic review of the literature was undertaken.
CONCLUSIONS: Early recognition and treatment of likely meningococcal sepsis has led to decreased mortality. Since the start of vaccination against serogroup C, the prevalence of this disease has decreased. Not only the possible presence of a meningococcal sepsis is important, but also the assessment of the shock state and the severity of disease and the possible presence of meningoencephalitis. There are also a number of genetic predispositions determining the severity of disease. The only three randomized trials in this disease have led to the conclusion that mortality is not a stable end point. Improvement in organ function, morbidity (including amputations), and functional outcome are better outcome measures.