In Norway a hyperendemic situation has persisted since 1974 as regards
meningococcal disease, with an adjusted annual incidence of almost 10 per 100,000 inhabitants. 80% of the cases are caused by group B meningococci, and the lethality has been about 10%. This article summarises the new Norwegian guidelines for the diagnosis and management of systemic
meningococcal disease. Clinical signs and symptoms are described, together with criteria for the classification of cases into four main categories: I Distinct
meningitis; II
Severe sepsis; III Simultaneous distinct
meningitis and
severe sepsis; IV Milder septicaemia and/or
meningitis. This type of classification is useful when choosing treatment, and for prediction and evaluation of the outcome. Hospital departments should establish appropriate routines for the management of such life-threatening
infections. In cases of suspected
meningococcal disease,
antibiotic treatment should be started within 15 minutes of admission. Initially,
benzylpenicillin and
chloramphenicol are recommended, to cover
haemophilus infection as well. When the diagnosis has been confirmed
chloramphenicol may be discontinued. Laboratory specimens are highly desirable, but sampling procedures should not delay start of treatment. As a main rule patients with
meningitis should have a spinal puncture. In severe septicaemia,
antibiotic treatment and management of
shock are given priority. All patients should be closely monitored. The condition of the patient may deteriorate rapidly. Detailed advice is given on laboratory tests and patient monitoring, and also on the management of
septic shock,
adult respiratory distress syndrome (ARDS),
brain edema,
renal failure and coagulation disturbances (
DIC).