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Suspected meningococcal disease — MSRA MCQ

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ModerateInfectious DiseasesSuspected meningococcal diseaseMSRA

A 21-year-old university student is assessed in the treatment room after 8 hours of fever, severe headache, vomiting and rapidly worsening myalgia. During the consultation, he develops a widespread non-blanching petechial rash over both legs and his trunk. He is confused, with a temperature of 39.6°C, pulse 128 beats/minute, BP 94/58 mmHg and capillary refill time of 4 seconds. He has no documented drug allergies. An ambulance can arrive in 12 minutes and the practice has IM ceftriaxone available. Which is the most appropriate immediate management plan?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Arrange emergency ambulance transfer and give IM ceftriaxone immediately, provided this does not delay transfer

This presentation strongly suggests meningococcal disease: acute febrile illness with rapidly evolving non-blanching rash, confusion, hypotension and impaired peripheral perfusion. This requires emergency hospital transfer, with pre-alerting of the receiving hospital. In strongly suspected meningococcal disease, NICE recommends IV or IM ceftriaxone or benzylpenicillin as soon as possible outside hospital, unless giving it delays transfer. IM ceftriaxone is therefore appropriate here while the ambulance is being arranged. A is inappropriate because, unlike uncomplicated suspected bacterial meningitis with prompt transfer, strongly suspected meningococcal disease warrants pre-hospital parenteral antibiotics where this can be done without delaying conveyance. B risks delaying both treatment and transfer for an investigation that should not be prioritised in primary care. C unnecessarily delays treatment for specialist discussion. E invents a transfer-time threshold: NICE specifies no numerical delay threshold and recommends immediate treatment for strongly suspected meningococcal disease if it does not delay transfer.

Reference: Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management — Recommendations (19 March 2024) — https://www.nice.org.uk/guidance/ng240/chapter/recommendations Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management — Rationale and impact (19 March 2024) — https://www.nice.org.uk/guidance/ng240/chapter/Rationale-and-impact