Updated 11 August 2015

Answer: What's your diagnosis? – Case 22

Mrs B took her 15 year old son, Boy X, to the doctor with symptoms of severe vomiting, headaches and a strange rash. It appears that the boy suffers from a potentially fatal condition called meningococcal meningitis.


Meningococcal meningitis is a potentially fatal condition, and a diagnosis should be be made early to avoid potentially life threatening complications.

Caused by viruses and bacteria

Menigitis, or the inflammation and infection of the meninges (the membranes covering the brain and spinal cord), can be caused by viruses and bacteria. Meningococcal meningitis is caused by the bacteria Neisseria meningitidis. This bacterium is responsible for most bacterial meningitis infections in children.

The condition presents with typical meningitis symptoms (as with Boy X) which includes:

- Headaches

- Malaise

- Stiff neck (meningism)

- Sensitivity of eyes to light (photophobia)

- Very high, persistent fever

- Joint pains

- Nausea

- Vomiting

As the condition progresses, a change in behaviour may occur. Severe lethargy, irritability, sweating, and incoherent speaking and thoughts may develop.

With meningococcus, patients usually have a typical rash which may look like bruising. What is very important to watch out for with the rash is that it does not blanch (turns white when pressed on). This is a sign of septicaemia (blood infection).

Diagnosis of the condition is made with proper history taking, clinical examination and laboratory testing. The doctor, on examination, will look for signs of septicaemia, meningism and meningeal irritability.

A lumbar puncture will be performed. Usually, with infection, the crystal clear spinal fluid appears turbid. Direct microscopy and incubation of the spinal fluid will be done. Once the presence of bacteria has been confirmed, the laboratory will do further testing to determine to which antibiotics the organism is sensitive to.

In-hospital antibiotic treatment with supportive symptomatic treatment is the mainstay.

If left untreated, meningococcus meningitis can cause deafness, paralysis, brain damage and even death. If any of the signs of meningitis are present, a doctor should examine the patient to exclude meningitis, and if diagnosed, administer the appropriate treatment.

Vaccines against meningococcal disease are available. These vaccines are of particular importance in central African countries where meningococcus meningitis is common.

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis - Case 1: vomiting and weight loss

What's your diagnosis - Case 2: eye pain

What's your diagnosis - Case 3: strange behaviour and a bullet in the back

What's your diagnosis - Case 4: seeing odd things

What's your diagnosis - Case 5: mysterious lungs

What's your diagnosis - Case 6: runner with seizures

What's your diagnosis - Case 7: swollen knee

What's your diagnosis - Case 8: bloody semen

What's your diagnosis - Case 9: confusing neurological signs

What's your diagnosis - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis - Case 11:bruising with no apparent cause

What's your diagnosis - Case 12: severe tummy pain

What's your diagnosis - Case 13: severe sore throat

What's your diagnosis - Case 14:abdominal pain and swelling

What's your diagnosis - Case 15: the world is spinning

What's your diagnosis? – Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? – Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

What's your diagnosis? – Case 20: chest pain next to breastbone

What's your diagnosis? – Case 22: vomiting and headaches

Image: Meningitis from Shutterstock

Dr. Owen J. Wiese is Health24's resident doctor. After graduating from Stellenbosch University with additional qualifications in biochemistry and physiology he developed a keen interest in providing medical information through the media.


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