Mild meningococcaemia, pyrexia protocols and a problematic public health response

Meningococcal septicaemia was masked by an acute tonsillitis in a university student presenting to the emergency department. The diagnosis was made as a result of routine blood culture and resulted in the patient being recalled for appropriate treatment. Although the patient was relatively well, public health contact tracing and prophylaxis ensued as per any other case of meningococcal disease. This case highlights the protean manifestations of meningococcaemia and the importance of evidence-based protocols. Blood culture guidelines led to the diagnosis in the absence of clinical suspicion and in sharp contrast to the paucity of evidence informing the public health response in this area. Copyright 2014 BMJ Publishing Group.