[Guidelines for the diagnosis and treatment of meningococcal disease at hospitals].

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).