During a meningococcal (group A) epidemic, 47 Nigerian children with acute meningococcaemia without meningitis were studied. Their mortality rate was 43% compared with 8% during the whole epidemic. Those presenting with coma and shock had a mortality of 93%, but without shock or coma mortality was only 6%. Coma or shock occurring alone carried an intermediate prognosis. The outcome correlated with initial serum antigen titre, but not with the serum levels of endotoxin, cortisol, or fibrin degradation products. Chloramphenicol was as effective as penicillin. A predictor of expected mortality, based on serum antigen titre and the presence of coma or shock, may allow new forms of treatment to be assessed.
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