Meningitis

• The Disease
  • Types
  • Personal stories
  • Symptoms
    • The rash
  • After effects
  • Facts and figures
  • Surveillance
  • FAQs
  • Medical Glossary
• The Research
• Help & Advice
• Education

The rash

It is so important to be able to recognise the symptoms of meningitis and septicaemia – it could, after all, mean the difference between life and death. Thankfully, nowadays, many people know to look for a rash that will not fade under pressure. But what exactly is this rash, why and where does it occur, and how is it different from other rashes?

The aim of this edition’s Science Series is to provide answers to these questions, which we hope will make the identification of ‘the rash’ a lot clearer.

Firstly, it is important to recognise that the rash is a symptom of meningococcal septicaemia, as opposed to meningococcal meningitis - however both conditions are caused by the meningococcus bacteria entering the blood stream.

As the meningococcal bacteria multiply in the blood stream, toxins are released, which leads to damage of the tiny blood vessels, known as capillaries. The capillaries begin to leak and small bruise-like spots are formed under the surface of the skin. These spots, which may look like pin prick marks, are known as petechiae.  They are tiny, non-raised, red or purple spots that are round and less than 2mm in diameter. (Although some people may have a petechial rash with viral infections, it should be assumed that petechiae are caused by meningococcal infection until proved otherwise and medical assistance should be sought if this type of rash is found). 

As meningococcal infection worsens, and the capillaries become more damaged, the petechiae develop into larger (greater than 2mm diameter) purple bruises. This is known as the purpuric rash, and will occur in approximately 50% of cases of meningococcal septicaemia.  By contrast with the petechial rash, purpuric spots may have an irregular outline.  Some may become blister-like or become ulcerated, with breaks in the surface.

Over hours, the rash can develop and appear anywhere on the body, although it is often found on the torso and legs. Initially, there may only be a few petechia, so it is important to check the whole skin surface thoroughly. The rash may also appear more like bruising, or as a freckle or blemish, as opposed to the typical petechial rash. On darker skin the rash may be difficult to see but may be visible in paler areas such as the palms of the hands, soles of the feet or the inner eyelids, so be sure to check these areas as well.

The tumbler test is an effective way of indentifying the rash caused by meningococcal septicaemia. If the spots or bruises do not fade when a clear drinking glass is pressed firmly against them, it could be meningococcal septicaemia.

Whilst it is important to remember that the rash associated with meningococcal septicaemia is one of the most prominent symptoms of the disease and that recognising it could save lives, it is, perhaps, also important to be aware that the rash may be a ‘late’ symptom in some people. It is crucial that you do not wait for a rash to appear before seeking medical help if your child, or someone you know, is unwell.  It is important to be aware of all the possible symptoms of meningitis and meningococcal septicaemia. If you are concerned, please trust your instincts and seek medical advice straight away.

It is also worth noting that in a third of cases of meningococcal septicaemia, there may be a macular or macular-papular rash - a flat or raised rash that, by contrast with the petechial or purpuric rash, does fade under pressure. This type of rash is common in viral infections and is different to petechiae and purpura.  This macular rash may occur early, then disappear before the petechiae or purpura appear. 

In summary, if your child, or someone you know, develops a rash which does not fade with the "tumbler test", it may be due to meningococcal disease and you should seek medical advice as soon as possible.