Recognizing meningococcal disease: the case for further research in primary care

Most studies describing the clinical presentation of meningococcal disease use data derived from hospital-based studies. This paper reviews current knowledge on the presentation of meningococcal disease from a primary care perspective. In a small proportion of cases with classical features, making the diagnosis may be relatively simple. In many cases, however, the general practitioner (GP) is faced with the difficulty of discriminating between the rare patient with life-threatening illness and the vast majority who present with similar symptoms secondary to self-limiting viral illness. In the absence of reliable means of excluding the disease, GPs will need to consider the possibility of meningococcal disease in all ill and febrile patients in whom no cause is apparent. Planned follow-up and clearer explanation to patients may increase the chance of identifying earlier those cases that evolve with time. More research is required to identify key clinical and contextual features that help GPs to predict or exclude serious disease, and to describe how this information is used in decision-making. A framework for conceptualizing the problems of researching illness is provided, which takes into account the many factors that influence clinical practice in primary care.