Your articles on meningococcal deaths in campuses give the impression that one of the deceased, Loy Cheah Kee, did not in fact die of meningitis, thus implying that there is no evidence as yet to link his death with that of his campus-mate D Thiyagarajan, both 23.

An important omission on your editor's part is not to have inform readers that the meningococcal disease can be present in forms other than meningitis, some even more deadly. Youths between ages 15 and 24 infected with Neisseria meningitidis often die of meningogoccal septicemia which can cause profound shock, hypertension and multi-organ failure. They can also die of adrenal failure because of bleeding and destruction of the adrenal glands.

A very rapidly fatal form of the disease is known as the Waterhouse-Friderichen syndrome or fulminant meningococcemia, which will cause death within hours from the onset. In fact US studies have shown that the disease is more dangerous among this age group because a higher percentage of the infected succumbed to the non-meningococcal forms of disease.

With such background information, we can surmise (since real information is withheld, the only thing we can do is to make intelligent guesses) that Loy might have died of non-meningococcal forms of the meningococcal disease, most likely fulminant meningococcemia.

The certification of "acute pulmonary oedema" as the "immediate cause of death" is consistent with pre-terminal events of patients dying from fulminant meningococcemia.

In the death certificate, there should be another column to the effect of "primary cause of death" (any disease that contributes significantly to death and most likely to have resulted in the immediate cause of death). If this latter column was left unfilled even when the meninigococcus bacterium had been found in Loy's body, this would be a blatant suppression of the truth.

If anyone had the impression that in urgent cases, as those of the two unfortunate UPM students, diagnosis takes a long time to establish, they are wrong. Samples taken from blood, CSF and subcutaneous bleeding points can be subjected to a rapid Gram staining (10-minute) procedure.

In the face of such overwhelming clinical presentation, the picture of Gram-negative (staining pink) paired coccus-shaped bacteria in such samples both inside and outside cells can be presumptive of the diagnosis of meningococcal disease.

Editor's note : The letter writer's professional input is much appreciated.