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Diagnosing invasive meningococcal disease (IMD)

IMD is an emergency

Suspected IMD requires immediate recognition, prompt referral to specialist care and urgent antibiotic treatment to reduce the risk of severe morbidity and mortality.1-3

IMD can present in different ways:4

Illustration representing that invasive meningococcal disease can present in different ways: IMD most commonly presents as: Meningococcal meningitis, Meningococcal sepsis. Less commonly, IMD presents as: Conjunctivitis , Pharyngitis, Pneumonia , Myocarditis, endocarditis, pericarditis, Urethritis, cervicitis , Arthritis.

Recognising the signs and symptoms of IMD

IMD can be a rapidly evolving condition and may present with non-specific signs and symptoms.3 It should be strongly suspected in those with the red flag combination of symptoms shown below; however, the absence of these symptoms does not rule out the possibility of IMD.3 Infants are more likely to present with non-specific signs and symptoms.5

Red flag combination of IMD symptoms3

  • Haemorrhagic, non-blanching rash with lesions larger than 2 mm
  • Rapidly progressive and/or spreading non-blanching rash
  • Any symptoms of meningococcal meningitis, when combined with the rash
     

Meningococcal meningitis and meningococcal sepsis can occur together.5 Patients may exhibit a spectrum of symptoms depending on disease stage, disease severity, age and individual factors.1

Assessing the rash

Icon representing a shingles rash

A non-blanching rash may appear as:5

  • A petechial rash (red or purple non-blanching macules smaller than 2 mm in diameter)
  • A purpuric (haemorrhagic) rash (spots larger than 2 mm in diameter). This may be absent in the early phase of the infection and may present initially as a blanching or macular rash before progressing

The whole body should be examined (including nappy areas in infants) for rash and unusual skin colour. The rash may be hard to detect on brown, black or tanned skin.5

Examples of the non-blanching rash:

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Age-dependent considerations

Signs and symptoms may be difficult to identify, appear differently or be specific to the age of the patient:5

  • Infants and children with meningococcal meningitis commonly present with non-specific signs and symptoms that can be difficult to distinguish from other infections, such as:
    • Fever
    • Vomiting
    • Irritability 
    • Reduced feeding in babies
    • Upper respiratory tract symptoms
  • Altered consciousness may be missed in young people or incorrectly attributed to alcohol or substance misuse
  • Delirium and altered consciousness in older adults may be missed
  • Neck stiffness may be harder to identify in adults with cognitive impairment, communication difficulties, dementia or arthritis

Be on heightened alert for IMD in at-risk groups

Icon representing the need to be alert for invasive meningococcal disease in at-risk groups

Anyone can develop IMD, however, incidence is highest in infants and adolescents.4 It is important to be on heightened alert for the possibility of IMD, especially in people with certain risk factors.

IMD can have devastating impacts for patients and their families.

Meningococcal meningitis is a notifiable disease and is required to be reported to the UK Health Security Agency2,4

Cases of meningococcal meningitis or septicaemia must be reported by registered medical practitioners as notifiable diseases under the Health Protection Legislation (2010). This requirement applies across the UK.2,4

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Disease overview

Read more about the risk factors for IMD.

LEARN MORE

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Epidemiology

Read more about epidemiology of IMD and its impact on individuals and society

LEARN MORE

References

  1. Ciftci E et al. Current methods in the diagnosis of invasive meningococcal disease. Front Pediatr 2025;13:1511086.
  2. UK Health Security Agency. Guidance for public health management of meningococcal disease in the UK. https://assets.publishing.service.gov.uk/media/673257250a2b4132b43d1448/UKHSA-meningo-disease-guidelines-november2024.pdf (accessed December 2025).
  3. National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. https://www.nice.org.uk/guidance/ng240 (accessed December 2025).
  4. UK Health Security Agency. Meningococcal: The Green Book, chapter 22 (June 2025). https://assets.publishing.service.gov.uk/media/6849adb83a2aa5ba84d1df71/Meningococcal-green_book_chapter-22-10-6-25.pdf (accessed December 2025).
  5. National Institute for Health and Care Excellence. Clinical Knowledge Summaries. Meningitis - bacterial meningitis and meningococcal disease: When should I suspect bacterial meningitis or meningococcal disease? https://cks.nice.org.uk/topics/meningitis-bacterial-meningitis-meningococcal-disease/diagnosis/when-to-suspect/ (accessed December 2025).
  6. McGill F et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect 2016;72:405-438.

Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/. Adverse events should also be reported to GlaxoSmithKline on 0800 221 441.

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January 2026 | NP-GB-MNU-WCNT-250002 (V1.0)