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March 20, 1987

The Diagnosis of Meningococcal Meningitis

JAMA. 1987;257(11):1474-1475. doi:10.1001/jama.1987.03390110050023

To the Editor.—  That the presence of petechiae is a useful predictor of meningococcal meningitis,1 differentiating it from other types of purulent meningitis, validates one of the earliest names of the disease, "petechial fever." Petechiae associated with meningococcal meningitis occur during the meningococcemic stage and are caused by the plugging of arterioles by meningococci.In contrast to the predictive approach, a simple and inexpensive diagnostic procedure is to lift off the top of the petechia, press a glass slide to the serum, dry, heat fix, and stain it with Gram's stain, and examine it under the microscope. The diagnosis can be made by anyone with an elementary knowledge of bacterial morphology. The results can be obtained within several minutes by anyone who has access to Gram's stain and a microscope. The diagnosis is definitive and early. In a fulminant case, this quick and early diagnosis may make the difference