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New data from the UK Health Security Agency (UKHSA) shows a significant rise in cases of invasive meningococcal disease (IMD) across England during 2022/23 compared with the previous year. Meningococcal disease is the collective name given to disease caused by Neisseria meningitidis. Infection with this bacteria can result in either meningitis or septicaemia (commonly known as blood poisoning) or both.
Meningitis can progress rapidly leaving survivors with serious health complications such as brain damage and hearing loss. Early diagnosis is vital to reduce the risks but this can be challenging (see recent article in the British Medical Journal). The National Institute for Health and Care Excellence (NICE) updated its guidance for clinicians in relation to bacterial meningitis and meningococcal disease in 2024. Charity Meningitis Now believes these new guidelines may be a significant turning point. Here I have a look at the key issues from my perspective as a specialist clinical negligence lawyer who works with clients affected by delays in the diagnosis of these conditions.
Meningitis is an inflammation of the protective membranes covering the brain and spinal cord. It can be caused by bacteria, viruses or fungi. Bacterial meningitis is the most severe form. Infection with neisseria meningitidis (meningococcal disease) is the most common cause of bacterial meningitis and up to ten percent of cases result in death. It can occur at any age but babies and young children are most at risk, with the next most vulnerable group being teenagers and young adults.
Previous NICE guidelines in this area covered only children under 16. The updated guidelines now also cover young people and adults - an important development in my view.
These guidelines set out that clinicians should have a ‘strong suspicion’ of bacterial meningitis when people have the following combination of red flag symptoms: fever, headache, neck stiffness and an altered level of consciousness or cognition.
For meningococcal disease itself there should be a strong suspicion when any of the following present: a haemorrhagic, non-blanching rash with lesions larger than 2mm, a rapidly progressing / spreading non-blanching or purpuric rash and any symptoms of bacterial meningitis when combined with such a rash. However, it is clearly stated that meningococcal disease should not be ruled out because there is no rash.
On examination, the whole body should be checked for a rash which, it is noted, can be difficult to detect on black, brown or tanned skin. As a result the guidelines state that there should be a check for petechiae (pin-point sized spots of bleeding) in the conjunctiva.
The guidelines flag that altered behaviour in young people and young adults can be incorrectly assumed to be caused by alcohol or substance abuse and this can lead to bacterial meningitis or meningococcal disease being missed.
People with suspected bacterial meningitis or meningococcal disease should be transferred to hospital as an emergency. The guidelines detail the circumstances in which antibiotics should be given before arrival at hospital, including where meningococcal disease is strongly suspected unless this would cause a delay in transfer to hospital.
Having arrived at hospital there should be an initial assessment by a senior clinical decision maker who should ensure that intravenous antibiotics start within one hour of arrival. Blood tests and a lumbar puncture (where safe to do so) should be performed before starting antibiotics for suspected bacterial meningitis. For suspected meningococcal disease, blood tests should be performed before antibiotics commence. For both conditions there should be a bacterial throat swab taken, preferably before antibiotics are started.
The updated guidelines do not cover all strains of meningitis excluding for example viral meningitis and neonatal meningitis.
Where NICE guidelines have not been followed, or there have been other failings, leading to a delay in the diagnosis and treatment, it may be possible to bring a claim for clinical negligence. In order to successful with such a claim, it must be shown that any delay was negligent and also that earlier treatment would have changed the outcome. This often requires the input of multiple experts including in the fields of microbiology and neurology. A specialist medical negligence solicitor will be able to advise fully.
If you would like to speak to our friendly and sensitive team for a no obligation discussion then please contact us on 020 7814 1200 or via our contact us page.
Further information
If you have any questions regarding this blog, please contact Rebecca Linnell in our Medical Negligence and Personal Injury team.
About the author
Rebecca is an Associate in the Medical Negligence Department who acts for a range of clients dealing with both medical negligence and personal injury claims. She assists the Partners in the Department with complex claims including negligence relating to spinal injuries, birth injuries, obstetric injuries, ophthalmic injuries and cases where there has been a fatality. She also has experience in dealing with issues surrounding patient consent and delays in diagnosis. Rebecca additionally assists clients who have sustained catastrophic injuries from road traffic accidents.
We welcome views and opinions about the issues raised in this blog. Should you require specific advice in relation to personal circumstances, please use the form on the contact page.
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