Meningococcal infections

Meningococcal infection refers to any illness caused by Gram-negative aerobic diplococcus bacteria called Neisseria meningitidis, also known as meningococcus. The Neisseria meningitidis (meningococcus) bacterium has a typical bean or kidney shape, and is an obligate human pathogen ¹. The Neisseria meningitidis microorganism frequently colonizes the oro- or nasopharynges of even healthy individuals, but can also colonize other parts of your body ¹. Meningococcal infections are often severe and can be deadly. They include infections of the lining of the brain and spinal cord (meningitis) and bloodstream infections (bacteremia or septicemia). Meningococcal infection is very serious and can be deadly in a matter of hours. Early diagnosis and treatment are very important.

The Neisseria meningitidis bacteria spread through the exchange of respiratory and throat secretions like spit (e.g., by living in close quarters, kissing). Doctors treat meningococcal disease with antibiotics, but quick medical attention is extremely important. Keeping up to date with recommended vaccines is the best defense against meningococcal disease.

Meningococcal infections causes

Bacteria called Neisseria meningitidis cause meningococcal infection. About 1 in 10 people have these bacteria in the back of their nose and throat without being ill. This is called being ‘a carrier’. Sometimes the bacteria invade the body and cause certain illnesses, which are known as meningococcal disease.

There are six serogroups (types) of Neisseria meningitidis — A, B, C, W, X, and Y — that cause most meningococcal infection worldwide. Three of these serogroups (B, C, and Y) cause most of the illness seen in the United States.

Meningococcal transmission

People spread meningococcal bacteria to other people by sharing respiratory and throat secretions (saliva or spit). Generally, it takes close (for example, coughing or kissing) or lengthy contact to spread these bacteria. Fortunately, they are not as contagious as germs that cause the common cold or the flu. People do not catch the bacteria through casual contact or by breathing air where someone with meningococcal disease has been.

Sometimes the Neisseria meningitidis bacteria spread to people who have had close or lengthy contact with a patient with meningococcal disease. Those at increased risk of getting sick include:

• People in the same household
• Roommates
• Anyone with direct contact with the patient’s oral secretions, such as a boyfriend or girlfriend

Close contacts of someone with meningococcal disease should receive antibiotics to help prevent them from getting the disease. Experts call this prophylaxis. This does not mean that the contacts have the disease; it is to prevent it. Health departments investigate each case of meningococcal disease to identify all close contacts and make sure they receive prophylaxis. People who are not a close contact of a patient with meningococcal disease do not need prophylaxis.

Risk factors for meningococcal infections

Certain people are at increased risk for meningococcal disease. Some risk factors include:

• Age: Age is an important risk factor for meningococcal pneumonia, which occurs mostly in older individuals > 50 years of age, and is the most common manifestation of meningococcal disease in those aged > 65 years, in contrast to meningococcal meningitis, which occurs predominantly in children and adolescents ². However, more recent data suggests that the age distribution of meningococcal pneumonia is bimodal, occurring before the age of 30 years and after 60 years of age ². Although all serogroups of the meningococcus can cause pneumonia, the less common serogroups of the pathogen are more frequently implicated as discussed below ². Doctors more commonly diagnose meningococcal disease in infants, teens, and young adults.
• Group settings: Infectious diseases tend to spread wherever large groups of people gather ³ Several college campuses have reported outbreaks of serogroup B meningococcal disease in recent years.
• Travelers to the meningitis belt in sub-Saharan Africa may be at risk for meningococcal disease.
• Certain medical conditions: Certain medical conditions and medications may weaken the immune system and increase risk of meningococcal disease.
  • Persistent complement component deficiencies: Complement component deficiencies refer to disorders of the ‘complement system,’ which helps the body fight off infections. Examples of complement component deficiencies include C3, C5-9, properdin, factor H, and factor D. These disorders are very rare and usually genetic.
  • People who take complement inhibitors such as eculizumab (Soliris®) and ravulizumab (Ultomiris™) are also at increased risk for meningococcal disease. Doctors most commonly prescribe complement inhibitors for three rare medical conditions:
  • Atypical hemolytic uremic syndrome, a blood disorder.
  • Paroxysmal nocturnal hemoglobinuria (PNH), a blood disorder
  • Generalized myasthenia gravis, a disorder that leads to muscle weakness
  • Functional or anatomic asplenia: Someone with anatomic asplenia does not have a spleen (for instance, if it was surgically removed). Someone with functional asplenia has a spleen but it doesn’t work the way that it should. People with sickle cell anemia have functional asplenia. The spleen is an important organ for fighting meningococcal infections because it helps produce antibodies and filter bacteria.
  • Human immunodeficiency virus (HIV) infection ⁴

Meningococcal prevention

Keeping up to date with recommended vaccines is the best defense against meningococcal disease. Maintaining healthy habits, like getting plenty of rest and not having close contact with people who are sick, also helps.

Although rare, people can get meningococcal disease more than once. A previous infection will not offer lifelong protection from future infections. Therefore, the Centers for Disease Control and Prevention (CDC) recommends meningococcal vaccines for all preteens and teens. In certain situations, children and adults should also get meningococcal vaccines.

Vaccination

Vaccines help protect against all three serogroups (B, C, and Y) of Neisseria meningitidis bacteria most commonly seen in the United States. Like with any vaccine, meningococcal vaccines are not 100% effective. This means there is still a chance you can develop meningococcal disease after vaccination. People should know the symptoms of meningococcal disease since early recognition and quick medical attention are extremely important.

As part of the licensure process, MenACWY and MenB vaccines showed that they produce an immune response. This immune response suggests the vaccines provide protection, but data are limited on how well they work. Since meningococcal disease is uncommon, many people need to get these vaccines in order to measure their effectiveness.

Available data suggest that protection from MenACWY vaccines decreases in many teens within 5 years. Getting the 16-year-old booster dose is critical to maintaining protection when teens are most at risk for meningococcal disease. Available data on MenB vaccines suggest that protective antibodies also decrease quickly (within 1 to 2 years) after vaccination.

There are 2 types of meningococcal vaccines:

1. Meningococcal conjugate or MenACWY vaccines
2. Serogroup B meningococcal or MenB (recombinant) vaccines.

The CDC recommends meningococcal vaccination for all preteens and teens. In certain situations, CDC also recommends other children and adults get a meningococcal vaccine. Below is more information about which meningococcal vaccines CDC recommends for people by age.

Talk to your or your child’s clinician about what is best for your specific situation.

Infants

The Centers for Disease Control and Prevention (CDC) recommends a meningococcal conjugate (MenACWY) vaccine for children as young as 2 months old and 10 years old  if they:

• Have a rare type of immune disorder called complement component deficiency
• Are taking a type of medicine called a complement inhibitor (for example, Soliris® or Ultomiris®)
• Have a damaged spleen or their spleen has been removed
• Have HIV
• Are traveling to or residing in countries in which the disease is common
• Are part of a population identified to be at increased risk because of a serogroup A, C, W, or Y meningococcal disease outbreak.

Talk to your child’s clinician to find out if, and when, they will need booster shots.

CDC recommends a serogroup B meningococcal (MenB) vaccine for children 10 years or older if they:

• Have a rare type of immune disorder called complement component deficiency
• Are taking a type of medicine called a complement inhibitor (for example, Soliris® or Ultomiris®)
• Have a damaged spleen or their spleen has been removed
• Are part of a population identified to be at increased risk because of a serogroup B meningococcal disease outbreak

Preteens and teens

CDC recommends MenACWY vaccination for all 11 through 18 year olds. All 11 to 12 year olds should get a MenACWY vaccine, with a booster dose at 16 years old (since protection decreases over time). This allows teens to continue having protection during the ages when they are at highest risk. Teens may also get a serogroup B meningococcal (MenB) vaccine, preferably at 16 through 18 years old.

While any teen may choose to get a serogroup B meningococcal (MenB) vaccine, certain preteens and teens should get it if they:

• Have a rare type of immune disorder called complement component deficiency
• Are taking a type of medicine called a complement inhibitor (for example, Soliris® or Ultomiris®)
• Have a damaged spleen or their spleen has been removed
• Are part of a population identified to be at increased risk because of a serogroup B meningococcal disease outbreak

Teens and young adults

Teens and young adults (16 through 23 year olds) may also be vaccinated with a serogroup B meningococcal (MenB) vaccine, preferably at 16 through 18 years old. Healthy teens and young adults who choose to get vaccinated need two doses of the same vaccine brand.

Adults

CDC recommends a MenACWY vaccine for adults if they:

• Have a rare type of immune disorder called complement component deficiency
• Are taking a type of medicine called a complement inhibitor (for example, Soliris® or Ultomiris®)
• Have a damaged spleen or their spleen has been removed
• Have HIV
• Are a microbiologist who is routinely exposed to Neisseria meningitidis
• Are traveling to or residing in countries in which the disease is common
• Are part of a population identified to be at increased risk because of a serogroup A, C, W, or Y meningococcal disease outbreak
• Are not up to date with this vaccine and are a first-year college student living in a residence hall
• Are a military recruit

Talk to your clinician to find out if, and when, you will need booster shots.

CDC recommends a MenB vaccine for adults if they:

• Have a rare type of immune disorder called complement component deficiency
• Are taking a type of medicine called a complement inhibitor (for example, Soliris® or Ultomiris®)
• Have a damaged spleen or their spleen has been removed
• Are a microbiologist who is routinely exposed to Neisseria meningitidis
• Are part of a population identified to be at increased risk because of a serogroup B meningococcal disease outbreak.

Who should NOT get Meningococcal vaccines?

Because of age or health conditions, some people should not get certain vaccines or should wait before getting them. Read the guidelines below and ask your or your child’s clinician for more information.

Tell the person who is giving you or your child a meningococcal vaccine if:

• You or your child have had a life-threatening allergic reaction or have a severe allergy.

DO NOT get a meningococcal vaccine if:

• You have ever had a life-threatening allergic reaction after a previous dose of that meningococcal vaccine.
• You have a severe allergy to any part of that vaccine. Your or your child’s clinician can tell you about the vaccine’s ingredients.

You are pregnant or breastfeeding.

• Pregnant women who are at increased risk for serogroup A, C, W, or Y meningococcal disease may get MenACWY vaccines.
• Pregnant or breastfeeding women who are at increased risk for serogroup B meningococcal disease may get MenB vaccines. However, they should talk with a clinician to decide if the benefits of getting the vaccine outweigh the risk.

You or your child are not feeling well.

• People who have a mild illness, such as a cold, can probably get these vaccines. People who have a moderate or severe illness should probably wait until they recover. Your or your child’s clinician can advise you.

Meningococcal vaccines side effects

Most people who get a meningococcal vaccine do not have any serious problems with it. With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own within a few days, but serious reactions are possible.

Mild Problems

• MenACWY Vaccines
  • Mild problems following MenACWY vaccination can include:
    • Reactions where the shot was given
    • Redness
    • Pain
    • Fever
    • Muscle or joint pain
    • Headache
    • Feeling tired

If these problems occur, they usually last for 1 or 2 days.

• MenB Vaccines
  • Mild problems following a MenB vaccination can include:
    • Reactions where the shot was given
    • Soreness
    • Redness
    • Swelling
    • Feeling tired
    • Headache
    • Muscle or joint pain
    • Fever or chills
    • Nausea or diarrhea

If these problems occur, they can last up to 3 to 5 days.

Problems that could happen after getting any injected vaccine

• People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell the clinician if you or your child feel dizzy, have vision changes, or have ringing in the ears.
• Some people get severe pain in the shoulder and have difficulty moving the arm where the clinician gave a shot. This happens very rarely.
• Any medicine can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses. These reactions happen within a few minutes to a few hours after the vaccination.
• As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

Antibiotics

Close contacts of a person with meningococcal disease should receive antibiotics to prevent them from getting sick. Experts call this prophylaxis (pro-fuh-lak-sis). Examples of close contacts include:

• People in the same household
• Roommates
• Anyone with direct contact with a patient’s oral secretions (saliva or spit), such as a boyfriend or girlfriend

Doctors or local health departments recommend who should get prophylaxis.

Meningococcal infection signs and symptoms

Seek medical attention immediately if you or your child develops symptoms of meningococcal infection. Symptoms of meningococcal disease can first appear as a flu-like illness and rapidly worsen. The two most common types of meningococcal infections are meningitis and septicemia (see the sections below). Both of these types of infections are very serious and can be deadly in a matter of hours.

Meningococcal infection diagnosis

Meningococcal disease can be difficult to diagnose because the signs and symptoms are often similar to those of other illnesses. If a doctor suspects meningococcal disease, they will collect samples of blood or cerebrospinal fluid (fluid near the spinal cord). Doctors then send the samples to a laboratory for testing. If Neisseria meningitidis bacteria are in the samples, laboratorians can grow (culture) the bacteria. Growing the bacteria in the laboratory allows doctors to know the specific type of bacteria that is causing the infection. Knowing this helps doctors decide which antibiotic will work best. Other tests can sometimes detect and identify the bacteria if the cultures do not.

Meningococcal infection treatment

Doctors treat meningococcal disease with a number of antibiotics. It is important that treatment start as soon as possible. If a doctor suspects meningococcal disease, they will give the patient antibiotics right away. Antibiotics help reduce the risk of dying.

This preemptive approach includes a third-generation cephalosporin antibiotics such as ceftriaxone or cefotaxime. If culture identifies the organism as penicillin-susceptible, treatment can be switched to penicillin G, although continuing third-generation cephalosporin treatment is also an option ⁵. For patients who have significant allergies to penicillin and other beta-lactams, chloramphenicol may be an alternative. The duration of antibiotic therapy is usually for five to seven days but can be up to twenty-one days, depending on the patient’s clinical response and culture sensitivity ⁶.

• Ceftriaxone dosing is 2 g (50 mg/kg in pediatric patients older than 1 month) intravenously (IV) every 12 hours, and cefotaxime dosing is 2 g (50 mg/kg in pediatric patients older than 1 month) every 6 hours.
  • Third-generation cephalosporins are generally preferable due to high efficacy and easier dosing.
• Penicillin dosing is 300,000 units/kg per day IV or intramuscularly (IM) with a maximum dose of 24 million units per day. Penicillin is usually given as 4 million units every four hours IV in adults and pediatric patients older than 1 month.
  • High-dose penicillin is recommended for cultures with a sensitivity of penicillin minimum inhibitory concentration 0.1 to 1.0 mcg/mL, although most clinicians will continue using third-generation cephalosporin instead.
• Chloramphenicol dosing is 50 to 100 mg/kg per day IV with a maximum dose of 4 g per day. It is usually given in divided doses every 6 hours.
  • Serum concentrations requires monitoring due to chloramphenicol toxicity.
  • Recommended therapeutic levels include a trough of 5 to 10 mcg/mL and a peak of 10 to 20 mcg/mL.
• Dexamethasone dosing is 0.15 mg/kg with a maximum dose of 10 mg every 6 hours.
  • Reportedly improves outcome in meningococcal meningitis
  • Ideally administered 4 hours prior to or concomitantly with antibiotics
  • Not recommended if tuberculosis meningitis is suspected
  • Not recommended if meningococcemia with shock is suspected

Patients with meningococcal infection should also be treated aggressively with supportive care, especially for sepsis or septic shock; this may include intravenous fluid resuscitation and vasopressors such as norepinephrine. Patients who show evidence of DIC may need aggressive hydration, blood transfusions, platelet replacement, and possibly even coagulation factor replacement. Researchers have proposed protein C as an adjuvant treatment, but its use is controversial and currently not commonly used ⁷.

Depending on how serious the infection is, people with meningococcal disease may need other treatments, including:

• Breathing support
• Medications to treat low blood pressure
• Surgery to remove dead tissue
• Wound care for parts of the body with damaged skin.

Meningococcal infection prognosis

The mortality rate of meningococcal infection can be as high as 50% in untreated patients. Early and aggressive treatment can reduce the mortality rate to approximately 10 to 14%. Early administration of antibiotics is imperative in determining a good outcome of meningococcal infection. Even with treatment, however, long-term complications can still occur in 11 to 19% of survivors. Complications of meningococcal disease include chronic pain, skin scarring, limb amputation, and neurological impairment ranging from hearing and visual impairments to motor function impairments. Hearing impairment and amputations occur in approximately 3% of cases, arthritis occurs in 10% of cases, and post-infection inflammatory syndrome occurs in 6 to 15% of cases ⁷.

Similar to other causes of bacterial meningitis, patients who survive meningococcal infections should follow up routinely. Hearing tests within four weeks of hospital discharge is recommended. Orthopedic follow-up and prosthetic fitting are necessary for patients who suffered limb amputations. Patients may even suffer from psychological and psychiatric complications, including post-traumatic stress disorder, depression, and behavioral abnormalities that may need to follow up with psychology and psychiatry ⁶.

Meningococcal infection complications

Even with antibiotic treatment, 10 to 15 in 100 people infected with meningococcal disease will die. Up to 1 in 5 survivors will have long-term disabilities, such as loss of limb(s), deafness, nervous system problems, or brain damage.

Meningococcal disease complications:

• Chronic meningococcemia
• Purpura fulminans
• Disseminated intravascular coagulation
• Acute respiratory distress syndrome
• Superinfections
• Pericarditis
• Coma
• Brain damage
• Limb loss
• Tenosynovitis
• Arthritis-dermatitis syndrome
• Urethritis
• Chronic pain
• Skin scarring
• Hearing impairment
• Visual impairment
• Motor function impairment
• Depression
• Post-traumatic stress disorder
• Behavioral abnormalities

Meningococcal meningitis

Doctors call meningitis caused by the bacteria Neisseria meningitidis meningococcal meningitis. When someone has meningococcal meningitis, the bacteria infect the lining of the brain and spinal cord and cause swelling.

Meningococcal meningitis symptoms

The most common symptoms of meningococcal meningitis include:

• Fever
• Headache
• Stiff neck

There are often additional symptoms, such as:

• Nausea
• Vomiting
• Photophobia (eyes being more sensitive to light)
• Altered mental status (confusion).

Newborns and babies may not have or it may be difficult to notice the classic symptoms listed above. Instead, babies may be slow or inactive, irritable, vomiting, feeding poorly, or have a bulging in the soft spot of the skull (anterior fontanelle). In young children, doctors may also look at the child’s reflexes for signs of meningitis.

If you or your child has any of these symptoms, see a doctor right away.

Meningococcal meningitis diagnosis

Initial diagnosis of meningococcal meningitis can be made by clinical examination followed by a lumbar puncture showing a purulent spinal fluid. The bacteria can sometimes be seen in microscopic examinations of the spinal fluid. The diagnosis is supported or confirmed by growing the bacteria from specimens of spinal fluid or blood, by agglutination tests or by polymerase chain reaction (PCR). The identification of the serogroups and susceptibility testing to antibiotics are important to define control measures.

Meningococcal meningitis treatment

Meningococcal meningitis treatment requires immediate admission to a hospital. To prevent serious neurologic morbidity and death, prompt institution of antibiotic therapy is essential when the diagnosis of bacterial meningitis is suspected. Surgical interventions may be necessary for the management of complications, such as subdural effusions, empyema, and hydrocephalus.

At presentation, meningitis due to Neisseria meningitidis may be impossible to differentiate from other types of meningitis. Thus, empirical treatment with an antibiotic with effective central nervous system (CNS) penetration should be based on age and underlying disease status, since delay in treatment is associated with adverse clinical outcome.

Initial empirical therapy until the etiology is established should include dexamethasone, a third-generation cephalosporin (eg, ceftriaxone, cefotaxime), and vancomycin. Acyclovir should be considered according to the results of the initial cerebrospinal fluid (CSF) evaluation. Doxycycline should also be added during tick season in endemic areas. A 7-day course of intravenous ceftriaxone or penicillin is adequate for uncomplicated meningococcal meningitis.

If imaging studies are indicated before lumbar puncture, draw blood for culture and begin administration of empiric antibiotics. Administration of empiric antibiotics is unlikely to decrease diagnostic sensitivity if CSF is tested for bacterial antigens early in the course of the illness.

Treatment following diagnosis

Once an accurate diagnosis of meningococcal meningitis is established, appropriate changes can be made. Currently, a third-generation cephalosporin (ceftriaxone or cefotaxime) is the drug of choice for the treatment of meningococcal meningitis and septicemia. Penicillin G, ampicillin, chloramphenicol, fluoroquinolone, and aztreonam are alternatives therapies (Infectious Diseases Society of America guidelines).

The use of dexamethasone in the management of bacterial meningitis in adults remains controversial. It may be used in children, especially in those with meningitis caused by Haemophilus influenzae. In adults with suspected bacterial meningitis, especially in high-risk cases, the adjunctive use of dexamethasone may be beneficial.

Meningococcal septicemia

Meningococcal septicaemia also known as meningococcemia or meningococcal bacteremia, is a bloodstream infection caused by Neisseria meningitidis bacteria. Meningococcemia is a medical emergency. When someone has meningococcal septicemia, the bacteria enter the bloodstream and multiply, damaging the walls of the blood vessels. This causes bleeding into the skin and organs.

People with meningococcemia are often admitted to the intensive care unit (ICU) of the hospital, where they are closely monitored. They may be placed in respiratory isolation for the first 24 hours to help prevent the spread of the infection to others.

Meningococcemia treatments may include:

• Antibiotics given through a vein immediately
• Breathing support
• Clotting factors or platelet replacement, if bleeding disorders develop
• Fluids through a vein
• Medicines to treat low blood pressure
• Wound care for areas of skin with blood clots

In developed countries there is a mortality rate of 10% from meningococcemia and 5% for meningococcal meningitis. Mild neurological complications such as vestibular nerve damage are common but serious brain damage is uncommon.

Figure 1. Meningococcemia rash

Meningococcal septicemia signs and symptoms

Meningococcal septicemia symptoms may include:

• Fever and chills
• Fatigue (feeling tired)
• Vomiting
• Cold hands and feet
• Severe aches or pain in the muscles, joints, chest, or abdomen (belly)
• Rapid breathing
• Diarrhea
• In the later stages, a dark purple rash (see photos)

If you or your child has any of these symptoms, see a doctor right away.

Meningococcemia rash, which may appear as follows:

• Small, red, flat or raised spots
• Progression of rash to larger red patches or purple lesions (similar in appearance to large bruises)

Later symptoms may include:

• A decline in your level of consciousness
• Large areas of bleeding under the skin
• Shock

In children older than 1 year, meningococcal meningitis symptoms may include:

• Fever
• Neck and/or back pain
• Headache
• Nausea and vomiting
• Neck stiffness
• A purple-red, splotchy rash or skin discoloration may appear as the disease progresses

In infants, meningococcal meningitis symptoms are difficult to pinpoint and may include:

• Irritability
• Listlessness and sleeping all the time
• Refusing a bottle
• Crying when picked up or being held
• Can’t be comforted while crying
• Bulging fontanel (soft spot on an infant’s head)
• Behavior changes

The symptoms of meningococcal meningitis and meningococcemia may look like other conditions or medical problems. Always consult your child’s doctor for a diagnosis.

Meningococcal septicemia possible complications

Possible complications of this infection are:

• Arthritis
• Bleeding disorder (DIC or disseminated intravascular coagulation)
• Gangrene due to lack of blood supply
• Inflammation of blood vessels in the skin
• Inflammation of the heart muscle
• Inflammation of the heart lining
• Shock
• Severe damage to adrenal glands that can lead to low blood pressure (Waterhouse-Friderichsen syndrome)

Meningococcal septicemia diagnosis

Meningococcal disease can be difficult to diagnose because the signs and symptoms are often similar to those of other illnesses.

In addition to a complete medical history and physical exam, other tests may include:

If a doctor suspects meningococcal disease, they will collect samples of blood or cerebrospinal fluid (CSF) (fluid near the spinal cord).

Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection. Cerebrospinal fluid (CSF) is the fluid that bathes your brain and spinal cord. Doctors then test the samples to see if there is an infection and, if so, what germ is causing it. A Gram stain of cerebrospinal fluid (CSF) may show Gram-negative diplococci. If Neisseria meningitidis bacteria are in the samples, laboratorians can grow (culture) the bacteria. Growing the bacteria in the laboratory allows doctors to know the specific type of bacteria that is causing the infection.

An aspirate (material drawn in negative pressure from a syringe) from petechiae and meningococci can also be cultured from CSF or blood and detected by PCR (polymerase chain reaction). Knowing this helps doctors decide which antibiotic will work best. Other tests can sometimes detect and identify the bacteria if the cultures do not.

• Blood culture
• Culture of skin lesions or rash (not common)
• Other blood tests

Meningococcal septicemia treatment

Prompt treatment is needed for meningococcal infections. Antibiotics (for example, penicillin) are most commonly used. If a patient has severe allergies to penicillin, other antibiotics may be used to treat the infection. Five to seven days of antibiotic therapy is usually effective. A child with meningococcal meningitis or meningococcemia will usually require IV (intravenous) antibiotics and close observation in a hospital or intensive care unit (ICU).

Other treatment for meningococcal infections is supportive (aimed at treating the symptoms present). A child with severe infection may require supplemental oxygen or be put on a ventilator to assist with breathing.

Meningococcemia treatment

• Benzyl penicillin 2.4 g IV (intravenous) slowly should be given immediately for 7 days.
• Meningococcal vaccine against serogroup C is available. Meningococcal vaccine that covers some, but not all, strains of meningococcus is recommended for children age 11 or 12. A booster is given at age 16. Unvaccinated college students who live in dormitories should also consider receiving this vaccine. It should be given a few weeks before they first move into the dorm. Talk to your provider about this vaccine.
• Household, kissing or other close contacts of a case of meningococcal disease should be given oral rifampicin or ciproflaxin, (ciproflaxin should not be given to children), as prophylaxis.
• Immunization can be offered for a group C disease.

Re-Infection

Although rare, people can get meningococcal disease more than once. A previous infection will not offer lifelong protection from future infections. Therefore, CDC recommends meningococcal vaccines for all preteens and teens. In certain situations, children and adults should also get meningococcal vaccines.

Meningococcal septicemia prognosis

Early treatment results in a good outcome. When shock develops, the outcome is less certain. Even with antibiotic treatment, 10 to 15 in 100 people infected with meningococcal disease will die ⁸. About 11 to 19 in 100 survivors will have long-term disabilities, such as loss of limb(s), deafness, nervous system problems, or brain damage ⁸.

The condition is most life threatening in those who have:

• A severe bleeding disorder called disseminated intravascular coagulopathy (DIC)
• Kidney failure
• Shock

Meningococcal pneumonia

Meningococcal pneumonia occurs in between 5% and 15% of all patients with invasive meningococcal disease and is thus the second most common non-neurological organ disease caused by Neisseria meningitidis ⁹. Meningococcal pneumonia occurs mainly with serogroups Y, W-135 and B. Risk factors for meningococcal pneumonia have not been well characterised, but appear to include older age, smoking, people living in close contact (e.g. military recruits and students at university), preceding viral and bacterial infections, haematological malignancies, chronic respiratory conditions and various other non-communicable and primary and secondary immunodeficiency diseases.

Primary meningococcal pneumonia occurs in 5–10% of patients with meningococcal infection and is indistinguishable clinically from pneumonia caused by other common infectious pathogens. Fever, chills and pleuritic chest pain are the most common symptoms, occurring in > 50% of cases ². Productive sputum and dyspnoea are less common ². A rash may occur in patients with pneumonia and associated sepsis, but meningococcaemia is a rare accompaniment of pneumonia ². Neither laboratory findings nor radiological features allow differentiation from other causes of pneumonia ².

Diagnosis of meningococcal pneumonia may be made by the isolation of the organism in sputum, blood, or normally sterile site cultures, but is likely to underestimate the frequency of meningococcal pneumonia. If validated, PCR-based techniques may be of value for diagnosis in the future.

Patients who develop only meningococcal pneumonia with bacteremia, but without central nervous system involvement, usually recover with good outcomes and do not develop the catastrophic syndrome seen in meningococcemia ¹⁰.

Meningococcal pneumonia treatment

Prior to 1991, penicillin was the treatment of choice for meningococcal infections ². However, with the emergence of penicillin-resistant strains in 1991 ¹¹, in the setting of the high mortality associated with meningococcal disease, the empiric treatment recommendation was changed to a third generation cephalosporin ². Although not commonly done, should the microorganism be found to be sensitive to penicillin, therapy of meningococcal disease with high-dose penicillin may be considered. Concerningly, isolates of meningococci with decreased susceptibility to penicillin, as well as emerging resistance to other antibiotics, have been recognized in Spain, Europe, South Africa, the US, Canada and Brazil ¹², with the latter study also reporting resistance of the meningococcus to ciprofloxacin. Alternative drug choices include meropenem (unavailability of a third generation cephalosporin), chloramphenicol (for severe beta-lactam allergy), aztreonam (if chloramphenicol is unavailable in the case of severe beta-lactam allergy), or a fluoroquinolone, such as moxifloxacin (currently restricted in the US, due to consideration of meningococcal fluoroquinolone resistance and lack of controlled trials in meningococcal disease) ¹.

Although the optimal regimen for the treatment of meningococcal pneumonia per se has not been determined, it seems likely to be similar to that of meningococcal disease ². In fact, it has been noted that most cases of meningococcal pneumonia received penicillin before 1991 and that most received a cephalosporin after that date ⁴.

Corticosteroids have been used as adjunctive therapy in patients with meningitis, but their benefit appears to be evident in pneumococcal, rather than meningococcal, meningitis. Accordingly, these agents are not usually recommended in the clinical setting of meningococcal disease ¹³. Although there has been emerging evidence for the benefit of adjunctive corticosteroid therapy in patients with severe community-acquired pneumonia, there are no reports on the possible benefits of corticosteroids in severe meningococcal pneumonia ².

References

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