Acute Meningococcaemia: Recent Advances in Management (with Particular Reference to Children)

Boslego JW , Tramont EC. Neisseria meningitidis. In: Gorbach SL , Bartlett JG , Blacklow NR , eds Infectious Diseases. Ch 214. WB Saunders Co. Philadelphia, Pennsylvania. 1992; 1452–1458.

Hart CA , Rogers TRF. Meningococcal Disease (Review). J Med Microbiol 1993; 39:3–25.

Patel MS , Merianos A , Hanna N , et al. Epidemic meningococcal meningitis in Central Australia, 1987–1991. Med J Aust 1993; 158:336–340.

Schlech WF III , Ward JI , Band JD , et al. Bacterial meningitis in the United States, 1978 through 1981. JAMA 1985; 253:1749–1754.

Peltola H , Kataja JM , Makela PH. Shift in the age distribution of meningococcal disease as a predictor of an epidemic? Lancet 1982; 2:595–597.

Achtman M , Kusecek B , Morelli G , et al. A comparison of the variable antigen expressed by Clone IV-1 and subgroup C of Neisseria Meningitidis Serogroup A. J Infect Dis 1992; 65:53–68.

Moore PS. Meningococcal meningitis in Sub-Saharan Africa: A model for the epidemic process. Clin Infect Dis 1992; 14:515–525.

Tubkin SD. Neisseria meningitidis bacteraemia. Pediatr Infect Dis J 1982; 1:37.

Ackerman AD. Infectious diseases of importance to the pediatric intensivist. In Ch 26. Textbook of Paediatric Intensive Care 1987. Williams and Wilkins. Baltimore.

Goldschneider I , Gotschlich EC , Artenstein MS. Human immunity to the meningococcus I. The role of humoral antibodies. J Exp Med 1969; 129:1307–1326.

Goldschneider I , Gotschlich EC , Artenstein MS. Human immunity to the meningococcus II. Development of natural immunity. J Exp Med 1969; 129:1327–1348.

Gold R , Lepow ML. Present state of polysaccharide vaccines in the prevention of meningococcal disease. Adv Pediatr 1976; 23:71–93.

Ellison RT III , Kohler PF , Curd JG , et al. Prevalence of congenital or acquired complement deficiency in patients with sporadic meningococcal disease. N Engl J Med 1983; 308:913–916.

DeVoe IW. The meningococcus and mechanisms of pathogenicity. Microbiol Rev 1982; 46:162.

Densen P. Interaction of complement with Nmeningitidis and N. Gonorrhoea. Clin Microbiol Rev 1989; 2:S11.

Waage A , Brandtzaeg P , Halstenson A , Kierulf P , Espevik T. The complex pattern of cytokines in serum from patients with meningococcal septic shock. J Exp Med 1989; 169:333–338.

Brandtzaeg P , Mollnes TE , Kierulf P. Complement activation and endotoxin levels in systemic meningococcal disease. J Infect Dis 1989; 160:58–65.

Brandtzaeg P , Kierulf P , Gaustad P et al. Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease. J Infect Dis 1989; 159:195–204.

Schwartz B , Moore PS , Broome CV. Global epidemiology of meningococcal disease. Clin Microbiol Rev 1989; 2:S118–124.

Poolman JT , Lind I , Jonsdottir K , Froholm LO , et al. Meningococcal serotypes and serogroup B disease in Northwest Europe. Lancet 1986; 2:555–557.

Jones DM. Epidemiology of meningococcal infection in England and Wales. J Med Microbiol 1988; 26:165–168.

Harrison LH. The worldwide prevention of meningococcal infection. Still an elusive goal. JAMA 1995; 273(5):419–421.

Robinson P , Spelman D. Chemoprophylaxis against meningococcal infection. Matters arising. Med J Aust 1993; 159:138.

Frasch CE , Mocca LF. Strains of N. Meningitidis isolated from patients and their close contacts. Infect Immun 1982; 37:155–159.

Figen CAP , Kuijper EJ , Tija HG , et al. Complement deficiency predisposes for meningitis due to nongroupable meningococci and Neisseria related bacteria. Clin Infect Dis 1994; 18:780–784.

Moore PS , Harrison LH , Telzak EE , et al. Group A meningococcal carriage in travellers returning from Saudi Arabia. JAMA 1988; 260:2686–2689.

Cartwright KAV. Influenza A and meningococcal disease. Lancet 1991; 338:554–557.

Greenwood BM , et al. Meningococcal disease and season in Sub-Saharan Africa. Lancet 1985; 2:829–830.

Stuart JM , Cartwright KAV , Robinson PM , et al. Effect of smoking on meningococcal carriage. Lancet 1989; 2:723–725.

Moore PS , Hierholzer J , DeWitt W , et al. Respiratory viruses and Mycoplasma as cofactors for Group A meningococcal meningitis. JAMA 1990; 264:1271–1275.

Bohm RC , Balcbalk RA , Cerra FB , et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992: 101; 1644–1655.

Jafari HS , McCracken GH. Sepsis and septic shock: Review for clinicians. Pediatr Inf Dis J 1992; 11:739–749.

Saez-Llorens X , McCracken GH Jnr . Sepsis syndrome and septic shock in paediatrics: current concepts of terminology, pathophysiology, and management. J Pediatr 1993; 123:497–508.

Hayden WR. Sepsis Terminology in Paediatrics. J Pediatr 1994; 124:657–658.

Tesoro LJ , Selbst SM. Factors affecting outcome in meningococcal infections, AJDC 1991: 145; 218–220.

Jones DM , Abbott JD. Meningococcal disease in England and Wales. In: Vedros MA (ed). Evolution of meningococcal disease, Vol 1 Publisher Boca Ratom, FL, CRC Press 198; pp 65–90.

Grossman M. Bacterial and viral infections. 1982. In Ch 13. Pediatrics. Prentice-Hall International Inc.

Thompson APJ , Marzouk O , Sills JA , et al. Meningococcal disease (Review). J Med Microbiol 1993; 39:3–25.

Gedde-Dahl TW , Hoiby EA , Schillinger A , Lystad A , Bovne K. An epidemiological clinical and microbiological follow-up study of incident meningococcal disease cases in Norway, winter 1981–82. Material and epidemiology in the MenOPP project. MIPH Ann 1983;6:155–168.

Goldschneider I , Gotschlich EC , Artenstein MS. Human immunity to the meningococcus IV. Immunogenicity of Group A and Group C meningococcal polysaccharide in human volunteers. J Exp Med 1969; 1368–1384.

Keogh C , Fong Y , Marano MA et al. Identification of a novel TNFα from the livers of burned and infected rats. Arch Surg 1990; 125:79–85.42.

Danas P , Aimee R , Gysen P et al. TNF and IL-1 serum levels during severe sepsis in humans. Crit Care Med 17; 975–978.

Hack CE et al. Increased plasma levels of interleukin-6 in sepsis. Blood 1989;74:1704–10.

Moldawer LL. Biology of pro-inflammatory cytokines and their antagonists. Crit Care Med 1994; 22(7):S3-S-7.

Waage A , Halstensen A , Espevic T. Association between TNF in serum and fatal outcome in meningococcal disease. Lancet 1987; I:355–357.

Cerami A , Bentler B. The role of cachetin/TNFα in endotoxic shock and cachexia. Immunol Today 1988; 9:28–31.

Casey LC , Balk RA , Bone RC. Plasma cytokine levels correlate with survival in patients with the sepsis syndrome. Ann Int Med 1993;119:771–778.

Giradin E , Grau GE , Dyer JM , Roux-Lombard P , Lambert PH. TNFα and IL-1 in the serum of children with severe infectious purpura. N Engl J Med 1988; 319:397–400.

Dinarello CA , Wolff SM. The role of interleukin 1 in disease. N Eng J Med 1993; 328: 49 106–113.

Suffredin AF. Current prospects for the treatment of clinical sepsis. Crit Care Med 1994; 22:512–518.

Granowitz EV , Santos AA , Poutsiaka DD et al. Production of interleukin 1 receptor antagonist during experimental endotoxaemia. Lancet 1991; 338:1423–1424.

Giradin E , Roux-Lombard P , Grau GE , et al. The J5 study group. Imbalance between TNFα and soluble TNFα receptor concentration in severe meningococcaemia. Immunology 1992; 76:20–23.

Villard J , Roux-Lombard P , Hugli A , Dayer JM. Could natural inhibitors of TNFα modify the course of fulminant meningococcaemia? Crit Care Med 1993; 23(9):1396–1399.

Van Deuren, van der Ven-Jongekrijg, Demacher PNM et al. Differential expression of pro-inflammatory cytokines and their inhibitors during the course of meningococcal infections. J Infect Dis 1994;169:157–161.

Derkx B , Marchant A , Goldman M , et al. High levels of I1–10 during the initial phase of fulminant meningococcal septic shock. J Infect Dis 1995; 171(1):229–232.

Hazelzet JA , van der Voort E , Lindemann J et al. Relation between cytokines and routine laboratory data in children with septic shock and purpura. Intensive Care Med 1994; 20:371–374.

Pollack MM , Ruttiman UE , Getson PR et al. Paediatric risk of mortality score(PRISM). Crit Care Med 16:1110–1116.

Mizock BA , Falk JL. Lactic acidosis in critical illness. Crit Care Med 1990; 20:80–93.

Madden RM , Gill JC , Marlar RA. Protein C and Protein S levels in two patients with acquired purpura fulminans. Br J Haematol 1990; 75:112–117.

Francis RB et al. Semin Thromb Hemost 1990; 16:310–25.

Adcock DM , Hicks MJ. Dermatopathology of skin necrosis associated with purpura fulminans. Semin Thromb Hemost 1990; 16:83–92.

Suffradin A , Harpel PC , Parrillo JE. Promotion and subsequent inhibition of plasminogen activator after administration of intravenous endotoxin to normal subjects. N Engl J Med 1989; 320:1165–1172.

Cupperman M , Inkelis SH , Saladino R. The role of heparin in prevention of extremity and digit necrosis in meningococcal purpura fulminans. Pediatr Infect Dis J 1994;13:867–783.

Beutler B , Grau GE. TNFα in the pathogenesis of infectious disease. Crit Care Med 1993; 25:S43–S45.

Gonda Y , Hirata S , Saitsh K. Antithrombotic effect of recombinant soluble thrombomodulin on endotoxin induced DIC in rats. Thromb Res 1993; 71(4):325–335.

Powars D , Larsen R , Johnson J et al. Epidemic meningococcaemia and purpura fulminans with induced Protein C deficiency. Clin Infect Dis 1993; 17:254–261.

Van der Poll T , Buller HR , ten Cate H et al. Activation of coagulation after administration of TNFα to normal subjects. New Engl J Med 1990;322:1622–1627.

Oltrud B , Flaegstad T. Increased tissue thromboplastin activity in monocytes of patients with meningococcal infection related to unfavourable prognosis. Thromb Haemost 1983; 49:5–7.

Conway EM , Bach R , Rosenberg RD. TNF enhances expression of tissue factor mRNA in endothelial cells. Thromb Res 1989; 53:231–241.

Van der Poll T , Leuin M , Buller HR et al. Fibrinolytic response to TNFα in healthy subjects. J Exp Med 1991; 174:729–33.

Lorente JA , Garcia-Frade IJ , Landin L et al. Time course of haemostatic abnormalities in sepsis and relation to outcome. Chest 1993; 103:1536.

Fourrier F , Chopin C , Goudemend J et al. Septic shock, multi-organ failure, and disseminated intravascular coagulation. Compared patterns of Antithrombin III, Protein C and Protein S deficiencies. Chest 1992; 101(3):816–823.

Leclerc F , Hazelzet J , Jude B et al. Protein C and S deficiency in severe infective purpura of children. A study of 40 cases. Intensive Care Med 1992; 18(4):202–205.

Fijnvandraat K , Derx B , Peters M et al. Coagulation activation and tissue necrosis in meningococcal septic shock. Severely reduced Protein C levels predict a high mortality. Thromb Haemost 1995; 73(1):15–20.

Pollack MM , Fields A , Ruttiman UE. Sequential cardiopulmonary variables of infants and children in septic shock. Crit Care Med 1984; 12:554–559.

Pollack MM , Fields A , Ruttiman UE. Distribution of cardio-pulmonary variables in paediatric survivors and non survivors of septic shock. Crit Care Med 1985; 13:454–459.

Mar MF , et al. Haemodynamic study in meningococcal septic sock (review). Anales Espanoles De Pediatrica 1991; 11:21–25.

Gedde-Dahl TW , Bjark P , Hoiby EA , et al. Severity of meningococcal disease: Assessment by factors and scores and implications for management. Rev Inf Dis 1990; 12(6):973–990.

Mercier JC , Beaufils F, Hartmann JF , et al. Haemodynamic patterns of meningococcal shock in children. Crit Care Med. 1988; 16(1):27–33.

Busund R , Straume B , Revhaug A. Fatal Course in Severe Meningococcaemia. Clinical Predictors and Effective Transfusion Therapy. Crit Care Med 1993; 21:1699–1705.

Boucek MM , Boerth RC , Artman M et al. Myocardial dys-function in children with acute meningococcaemia. J Pediatr 1984; 105:538.

Stiehm ER , Damrosch DS. Factors in the prognosis of meningococcal infection. J Pediatr 1966; 68:457–467.

Niklasson P , Lundbergh P , Strandeil T. Prognostic factors in meningococcal infection. Scand J Infect Dis 1971; 3:17–25.

Lewis LS. Prognostic factors in acute meningococcaemia. Arch Dis Child 1979; 54:44–48.

LeClerc F , Beuscart R , Guillois B , et al. Prognostic factors of severe infectious purpura in children. Intensive Care Med 1985;11:140–143.

Kahn A , Blum D. Factors for the prognosis of fulminating meningococcaemia. Clin Pediatr(Phil) 1978;17:680–687.

Sinclair JF , Skeoch CH , Hallworth D. Prognosis of meningococcal septicaemia. Lancet 1987 ii:38.

Thomson APJ , Sills JA. Validation of the GMSPS:A 10 year retrospective survey. Crit Care Med 1991; 19(1):26–30.

Stockland T , Flaestad T , Gutteberg TJ. A clinical score for the prediction of outcome of patients with meningococcal infection. Acta Paediatr Scand 1985; S322:12.

Le Gall JR. Do we need a new severity score? 1991 Crit Care Med 19:857–858.

Shah A , Matthew DJ. GMSPS in meningococcal septicaemia Crit Care Med 1992; 20:1495.

Algren JT , Suresh L , Cutliff SA , et al. Predictors of outcome in acute meningococcal infection in children. Crit Care Med 1993; 21(3):447–452.

McManus ML , Churchwell KB. Coagulopathy as a predictor of outcome in meningococcal sepsis and the systemic inflammatory response with purpura. Crit Care Med 1993; 21(5):706–711.

Berron S , Vazquez JA. Increase in moderate penicillin resistance and serogroup C in meningococcal stains isolated in Spain. Is there a relationship? Clin Infect Dis 1994; 18:161–165.

Saez-Nieto JA , Lujan R , Berron S , et al. Epidemiology and molecular basis of penicillin-resistant Neisseria Meningitidis from Spain: a five year history (1985–89). Clin Infect Dis 1992; 14:394–402.

Meningococcal isolate surveillance; Australia 1994. CDI 1995; 19(12): 286–289.

Ziegler EJ , McCuthan JA , Fierer J et al. Treatment of Gram-negative bacteraemia and shock with human antiserum to a mutant E Coli. N Engl J Med 1982; 307:1225–1230.

Baumgartner JD , Glauser MP , McCuthan JA et al. Prevention of Gram- negative shock and death in surgical patients by antibody to endotoxin core glycolipid. Lancet 1985, Vol 11:59–63.

Calandra T , Glauser MP , Schellekens J et al. Treatment of Gram-negative septic shock with human IgG antibody to Esherishia Coli J5. J Infect Dis 1988; 158:312–319.

J5 study group: Treatment of severe infectious purpura in children with human plasma from donors immunised with Esherishia Coli J5: a perspective double-blind study. J Infect Dis 1992; 165:695–701.

Ziegler EJ , Fisher CJ , Sprung CL , et al. Treatment of Gram-negative bacteraemia and septic shock with HA–1A human monoclonal antibody against endotoxin. N Engl J Med 1991; 324:429–436

McClosky RV , Straube RC , Sanders C , et al. Treatment of septic shock with HA-1A: a randomised double-blind placebo controlled trial. CHESS trial study group. Ann Int Med 1994; 121 (1):1–5.

French National Registry of HA-1A in septic shock. A cohort study of 600 patients. Arch Int Med 1994; 154(21):2484–2491.

Luce JM. Introduction of new technology in critical care practice. A history of H1-1A human monoclonal antibody against endotoxin. Crit Care Med 1993; 21:1233–1234.

Wester JPJ , Breumelhof R , Geers ABM. Monoclonal antibodies in the treatment of adult fulminant meningococcaemia. Euro J Med 1992; 1:372–373.

Syed SA , Taylor RH , Crean PM , Stewart RJ. Successful use of monoclonal anti-lipid A IGM in an infant with meningococcal septicaemia. Lancet 1992; 33:496.

Fisher CJ , Opal SM , Dhainaut JF , et al. Influence of anti tumour necrosis factor monoclonal antibody on cytokine levels in patients with sepsis. Crit Care Med 1993; 21:318–327.

Abraham E , Wunderink R , Silverman H et al. Efficacy and safety of monoclonal antibody to human TNFα in patients with sepsis syndrome. A randomised, controlled, double-blind, multicentre clinical trial. TNFα MAb sepsis study group. JAMA 1995; 273(12):934–941.

Jin H , Yang R , Marsters SA et al. Protection against rat endotoxic shock by P55 TNFα receptors immunoadhesin: comparisons with anti- TNFα monoclonal antibody. J Infect Dis 1994; 170(5):1323–1326.

Fisher CJ Jnr, Dhairait JF, Pribble JP et al. A study evaluating the efficacy of human recombinant interleukin 1 receptor antagonist (IL-1 RA) in the treatment of patients with sepsis syndrome. Preliminary results. Clin Intens Care 1993; 4:85.

Mustafa MM , Ramilo O , Mertsola J et al. Modulation of inflammation and cachectin activity in relation to treatment of experimental Haemophilus influenzae type B meningitis. J Infect Dis 1989; 160:818–825.

Tauber M , Khayam-Bushi H , Sande MA. Effects of ampicillin and corticosteroids on brain water content, CSF pressure and CSF lactate levels in experimental pneumococcal meningitis. J Infect Dis 1985; 151:528–533.

Odio et al. Beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis. N Engl J Med 324(22):1524–1531.

McCracken GH Jnr, Label MH. Dexamethasone treatment for bacterial meningitis in infants and children. AJDC 1989; 143:287–289.

Havens PL , Wendelberger KJ , Hoffman GM et al. Corticosteroids in adjunctive therapy in bacterial meningitis. A meta analysis of clinical trials. AJDC 1989; 143:1051–1055.

Girgis NI , Farid Z , Michail IA et al. Dexamethasone treatment for bacterial meningitis in children and adults. Pediatr Infect Dis J 1989; 8:848–851.

Kennedy WA , Hoyt MJ , McCracken GH Jnr . The role of corticosteroid therapy in children with pneumococcal meningitis. AJDC 1991; 145:1374–1378.

Bhatt SM , Cabellos C , Nadol JB Jnr et al. The impact of dexamethasone on hearing loss in experimental pneumococcal meningitis. Pediatr Infect Dis J 1995; 14:93–96.

Syrogiannopoulos GA , Lourida AN , Theodoridou MC. Dexamethasone therapy for bacterial meningitis; 2 versus 4 day regimen. J Infect Dis 1994; 169:853–858.

Schaad UB , Lips U , Gnehm HE et al. Dexamethasone therapy for bacterial meningitis in children. Lancet 1993; 342:457–461.

The report of the committee on infectious diseases, American Academy of Paediatrics. 23rd edition. Elk Grove Village, IL; American Academy of Paediatrics 1994; 220–229, 323–326, 558–559.

The meningitis working party of the British paediatric immunology and infectious diseases group. Should we use dexamethasone in meningitis? Arch Dis Child 1992; 67:1398–1401.

Schein RMH , Sprung CL , Marcial E et al. Plasma cortisol levels in patients with septic shock. Crit Care Med 1990; 18:259–263.

Wajchenberg B , Leme CE , Tambascia M , et al. The adrenal response to exogenous adrenocorticotrophin in patients with infections due to Neisseria meningitis. J Infect Dis 1978 138(3); 387–391.

Beutiler B , Krochin N , Milsark IW et al. Control of cachectin (TNFα) synthesis: mechanisms of endotoxin resistance. Science 1986; 232:977–980.

Saez-Llorens X , Ramilo O , Mustafa MM et al. Molecular pathophysiology of bacterial meningitis: current concepts and therapeutic implications. J Pediatr 1990; 116:681–684.

Sprung C , Caralis PV , Marcial EH et al. The effects of high dose corticosteroids in patients with septic shock: a prospective controlled study. N Engl J Med 1984; 311:1137–1143.

Hoffman SL , Punjabi NH , Kumala S et al. Reduction of mortality in chloramphenicol treated severe typhoid fever by high dose dexamethasone. N Eng J Med 1984; 310:82–88.

Bone RC , Fisher CJ , Clemmer TP et al. A controlled clinical trial of high dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 1987;317:653–658.

Veterans Administration Systemic Sepsis Cooperative Study Group. Effect of high dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. N Engl J Med 1987; 317:659–65.

Rothwell PM , Udwadia ZF , Lawler PG. Cortisol response to corticotrophin and survival in septic shock. Lancet 1991; 337:582–583.

Lefering R , Neugebauer EAM. Steroid controversy in sepsis and septic shock: A meta-analysis. Crit Care Med 1995; 23:1294–1303.

Rothwell PM , Udwadia ZF , Lawler PG. Cortisol response to corticotrophin and survival in septic shock. Lancet 1991; 337:582–583.

Soni A , Pepper GN , Wyrwinski PM et al. Adrenal insufficiency occurring during septic shock: incidents, outcome, and relationship to peripheral cytokine levels. Am J Med 1995; 98:266–271.

Briegel J , Kellerman W , Forst H et al. Low dose hydrocortisone infusion attenuates the systemic inflammatory response syndrome. The Phospholipase A2 Study Group. Clinical Investigator 1994; 72(10):782–787.

Mastorakos G , Chrousos GP , Weber JS. Recombinant interleukin 6 activates the hypothalamic-pituitary-adrenal access in humans. J Clin Endocrinol Metab 1993; 77:1690–1694.

Taylor FB , Chang AR Jr , Esmon CT , et al. Protein C prevents the coagulopathic and lethal effects of E. Coli infusion in the baboon. J Clin Invest 1987; 79:918–925.

Nardi M , Karpathin M. Prothrombin and Protein C in early childhood. Normal adult levels are not achieved until the fourth year of life. J Pediatr 1986; 117(5):843–845.

Dreyfus M , et al. Treatment of homozygous Protein C deficiency in neonatal purpura fulminans with purified Protein C concentrate. N Engl J Med 1991; 32:1565–1568

Rivad GE , Davies M , Farrell C. Treatment of purpura fulminans in meningococcaemia with Protein C concentrate. J Pediatr 1995; 126(4):646–652.

Gerson WT , Dickenson JT , Bovill EG. Severe acquired Protein C deficiency in purpura fulminans associated with DIC: treatment with Protein C concentrate. Pediatrics 1993; 91:418–420.

Pilcher L , Hruby E , Schwarz HP. Attenuation of the Schwartz-man reaction rabbits by human activated protein C. (Abstract) Thromb Haemost 1991; 65:1205.

Bick RL , Ancypa D. Blood protein defects associated with thrombosis. Clinics in Laboratory Medicine II 1995; 14(1):125–163.

Fourrier F , Lestravel P , Chopin C , et al. Meningococcaemia and purpura fulminans in adults. Acute deficiencies of Protein C and S, and early treatment with AT III concentrate. Intens Care Med 1990; 16:121–124.

Fourrier F , Chopin C , Huart JJ , et al. Double blind placebo controlled trial of AT III concentrates in septic shock with DIC. Chest 1993; 104:882–888.

van Beek EJ , van der Mollen MA , ten Cate JW. AT III concentrate in the treatment of DIC: A retrospective follow up study. Netherlands J Med 1994; 45(5):205–210.

Emerson TE Jr . AT III replacement in animal models of acquired AT III deficiency. Blood Coag d Fibrinol 1994; S1:S37–45

Harper PL. The clinical use of Antithrombin III in septicaemia. BJHM 1994;52(11):571–573.

Cobcroft R , Henderson A. Meningococcal purpura fulminans treated with AT III concentrate: what is the optimal replacement therapy? Aust NZ J Med 1994; 24:575.

Haneburg B , Gutteberg TG , Moe PJ et al. Heparin for infants and children with meningococcaemia: results of a randomised therapeutic trial. NIPH Ann 1983; 6:43–47.

Kupperman M et al. The role of heparin in preventing extremity and digit necrosis in meningococcal purpura fulminans. Ped Infect Dis J 1994; 13:867–873.

Du Toit HJ , Coetzee AR , Chalton DO. Heparin treatment in thrombin induced DIC in the baboon. Crit Care Med 1991; 19:1195.

Sakuragawa N et al. Clinical evaluation of low molecular weight heparins on DIC, a multi centre cooperative double blind trial in comparison with heparin. Thromb Res 1993; 72(6):475–500.

Lantz M , Thysell H , Nilsson E , et al. On the binding of TNFα to heparin and the release of in vivo TNFα binding protein I by heparin. J Clin Invest 1991; 88:2026–2031.

Stewart FJ , McClure BJ , Mayne E. Successful treatment of purpura fulminans using epoprostenol. J Roy Soc Med 1991; 84:623.

Winrow AP. Successful treatment of purpura fulminans using epoprostenol. J Roy Soc Med 1991; 85:245.

Klein NJ , Heyderman RS , Levin M. Management of meningococcal infections. BJHM 1993; 50(1):42–49.

Keeley SR , Matthews NT , Buist M. Tissue plasminogen activator for gangrene in fulminant meningococcaemia. Lancet 1991; 337:1359.

Zenz W , Muntean W , Gallistl S , et al. Recombinant Tissue Plasminogen Activator treatment in two infants with fulminant meningococcaemia. Pediatrics 1995; 96:144–147.

Scharfman WB , Tillotson JR , Taft EG. Plasmapheresis for meningococcaemia with DIC. N Engl J Med 1970; 30:1277–1278.

Bjorvatn B , Bjerknaes L , Fadnes HO , et al. Meningococcal septicaemia treated with continuous plasmapheresis and leucopheresis or with blood exchange. BMJ 1984; 288:439–441.

Westerndorp RG , Brandt A , Thompson J , et al. Experiences with plasma and leucopheresis in meningococcal septicaemia. Intensive Care Med. 1990; 16:S102.

Drapkin MS , Wish JS , Gelfland JA , et al. Plasmapheresis for fulminant meningococcaemia. Pediatr Inf Dis J 1989; 8:399–400.

Gardlund B , Sjolin J , Nilsson A. Plasmapheresis in treatment of primary septic shock in humans. Scand J Inf Dis 1993; 25(6):757–761.

Van Deusen M , Santman FW , Van Dalin R , et al. Plasma-pheresis and whole blood exchange in meningococcal sepsis. Clin Infect Dis 1992; 15:424–430.

Schetz M , Gasthuisberg UZ. Removal of cytokines in septic patients using continuous veno venous haemodiafiltration [letter:comment]. Crit Care Med 1994; 22(4):715–716.

Reimainn PN , Mason PD. Plasmapheresis: Technique and complications. Intensive Care Med 1990; 16:3–10.

Pollack M. Editorial response. Blood exchange and plasma-pheresis in septic shock. Clin Infect Dis 1992; 15:431–433.

Bellomo R , Tipping P , Boyce N. Continuous veno venous haemofiltration with dialysis removes cytokines from the circulation in septic patients. Crit Care Med 1993; 21:522–526.

Tonnesen E , Hansen MB , Hölmdorf et al. Cytokines in plasma and ultrafiltrate during continuous arteriovenous haemofiltration. Anaesth Intens Care 1993; 21:752–758.

Bellomo R , Tipping P , Boyce . Removal of cytokines in septic patients using continuous veno venous haemodiafiltration. Crit Care Med 1994; 22(4):719–721.

Best C , Walsh J , Sinclair J , Beattie J. Early haemodiafiltration in meningococcal septicaemia. Lancet 1996; 347:202.

Champion MP , Murdoch IA , Sajjanhar T , Marsh MJ. Extracorporeal membrane oxygenation in refractory shock in fulminant meningococcaemia. Lancet 1996:1–202.

Anderson CT , Berde CB, Sethna NF et al. Meningococcal purpura fulminans: Treatment of vascular insufficiency in a 2 year old with lumbar sympathetic blockade. Anesthesiology 1989; 21:463–464.

Tobias JD , Haun SE , Helfaer M , Nichols DG. Use of continuous caudal blockade to relieve lower extremity ischaemia caused by vasculitis in a child with meningococcaemia. J Pediatr 1989; 115:1019–1021.

Herrera R , Hobar C , Ginsburg C. Surgical intervention for the complications of meningococcal-induced purpura fulminans. Pediatr Inf Dis J 1994; 13:734–737.

Hamdy RC , Babyn PS , Krajbich JI. Use of bone scan in management of patients with peripheral gangrene due to fulminant meningococcaemia. J Pediatr Orthopaed 1993; 13:447–451.

Hart CA , Cuevas LE. Chemoprophylaxis of meningococcal disease. J Med Microbiol 1993; 39:3–25.

The meningococcal surveillance group. Analysis of endemic meningococcal disease by serogroup and evaluation of chemo-prophylaxis. J Infect Dis 1976; 134:201–204.

Schwartz B , Al-Tabaigi A , Al-Ruwais A , et al. Comparative efficacy of ceftriaxone and rifampicin in eliminating pharyngeal carriage of Group A N. meningitidis. Lancet 1988; I:1239–1242.

Abadi FJ , Yakubu DA , Pennington TH. Antimicrobial susceptibility of penicillin-sensitive and penicillin-resistant meningococci. J Antimicrob Chemother 1995; 35:687–690.

Gaunt PN , Lambert BE. Single dose Ciprofloxacin for the eradication of pharyngeal carriage of N. meningitidis. J Antimicrobial Chemother 1988; 21:489–496.

Frasch CE. Vaccines for the prevention of meningococcal disease. Clin Microbiol Rev 1989; 2:S134–138.

Bjune G , Hoiby EA , Gronnesby JK , et al. Effect of outer membrane vesicle vaccine against group B meningococcal disease in Norway. 1991 Lancet; 338:1093–1096.