Some arguments on early hospital admission and treatment of suspected meningococcal disease cases.

Arguments are presented which indicate or show that: (1) Diagnostic precision and severity level of systemic meningococcal disease (MCd) both seem to rise exponentially with the developmental stage of the disease at referral. Lowering of the clinical admission threshold improves early coverage of vaguely suspected cases and should probably be implemented in Norway. (2) Fear that cell wall active bactericidal antibiotics could trigger important endotoxin release may cause unnecessary treatment delays. (3) Although risk of death due to meningococcal septicemia is the main indication for early treatment of MCd, the risk of sequelae may also become a major cause for very early treatment of MCd. (4) Treatment delays for MCd cases could have been substantially reduced by implementing reasonable guidelines. (5) In the relations between the public and the health service both organizational and psychological factors are operating. (6) Increased awareness among professionals and lay people of some key symptoms and signs may facilitate earlier diagnosis of MCd. (7) Earlier treatment of meningococcal disease is now feasible and does seldom preclude the possibility of etiological diagnosis. (8) More relevant studies and information on the early phases and rapid management of MCd are highly desirable. Rapid diagnosis and treatment of MCd are very important to reduce death, sequelae and community costs and should be more advocated in training of health personnel and in public information.