Clinical features of severe disease

The diagram above illustrates the main causes of death from MD. In the majority of patients, one disease process predominates. Patients presenting with mixed disease will also tend, as the disease worsens, to become either profoundly septicaemic or profoundly meningitic. A few will have combined severe septicaemia with shock and severe meningitis with raised intracranial pressure and these need expert management. Patients presenting with septic shock without meningitis carry the worst prognosis^{8 13}. Although a few patients with meningitis will die from raised intracranial pressure, most deaths from MD result from shock and multi-organ failure¹⁴.

Features which predict poor prognosis at the time of presentation include^{13 14}

• Presence of shock
• Absence of meningism
• Rapidly progressive purpuric rash
• Low peripheral white blood cell count
• Thrombocytopenia
• Markedly deranged coagulation
• Depressed conscious level