We greatly appreciate the comments by Dr Ratner. Although it has been reported that the demonstration of meningococci on smears of petechiae is infrequent,1 the diagnostic procedure suggested by Dr Ratner may be useful in selected cases, ie, in those patients with a presumptive clinical diagnosis of meningococcal meningitis and a negative Gram's stain smear of cerebrospinal fluid.In a series of 45 adult patients with meningococcal meningitis,2 we found that the Gram's stain smear of cerebrospinal fluid was positive in 31 (69%) patients.We therefore think that when a diagnosis of meningococcal meningitis is considered, the most accurate, quick, and early diagnostic technique is the spinal tap.
Mancebo J, Domingo P, Blanch L, Net A, Nolla J. The Diagnosis of Meningococcal Meningitis-Reply. JAMA. 1987;257(11):1475. doi:10.1001/jama.1987.03390110050024