Case history 29 Until the evening prior to hospital admission, 18 year old Kevin Thomas was a fit and healthy student. On that evening he went to bed early complaining of a headache; he was also feverish. Early the next morning his mother, a nurse, went to check on him. He was clearly very ill, moaning quietly, with a very high temperature. He had vomited during the night. Mrs Thomas was so alarmed by Kevin's condition that she took him straight to the local A&E department where she worked, believing that he may be suffering from meningitis. On admission Kevin's temperature was 40oC, his heart rate was 126 and he was becoming increasingly drowsy. A rash noted on legs. Blood was sampled for among other tests, blood culture. In view of his rapidly deteriorating condition Kevin was given a broad-spectrum antibiotic intrave- admitted to the intensive care unit. Later that day the laboratory reported the presence of Gram-negative diplococci bacteria in the culture of Kevin's blood, which was subsequently identified as Neisseria meningitidis