Meningococcal disease

Last reviewed: 25 Aug 2022
Last updated: 18 Nov 2021

Summary

Definition

History and exam

Key diagnostic factors

  • rapid onset of illness
  • fever
  • irritability
  • leg pain
  • seizures
  • neck pain
  • headache
  • confusion
  • altered consciousness
  • hypotension
  • pallor or mottled skin
  • rash
  • cold hands and feet
  • neck stiffness
  • photophobia
  • hypotonia
  • high-pitched cry
  • Kernig sign
  • Brudzinski sign
  • bulging fontanel
More key diagnostic factors

Other diagnostic factors

  • lethargy
  • poor appetite or feeding
  • nausea or vomiting
  • thirst
  • coryza, sore throat, or cough
  • respiratory distress
  • tachycardia
Other diagnostic factors

Risk factors

  • young age
  • complement deficiency
  • use of eculizumab and ravulizumab
  • immunoglobulin deficiency
  • asplenia or hyposplenia
  • college attendance
  • close contact with invasive meningococcal infection
  • household crowding
  • recent move into a new community
  • travel to a hyperendemic or epidemic area
  • laboratory workers
  • tobacco smoke exposure
  • respiratory infection
  • visiting bars/clubs
  • kissing
More risk factors

Diagnostic investigations

1st investigations to order

  • blood cultures
  • CBC and differential
  • electrolytes, Ca, Mg, glucose
  • coagulation profile (prothrombin time, INR, activated PTT, fibrinogen, fibrin degradation products)
More 1st investigations to order

Investigations to consider

  • cerebrospinal fluid (CSF) Gram stain
  • CSF cell count and differential
  • CSF glucose, protein
  • CSF culture
  • antigen detection in CSF
  • chest x-ray
  • CT head
  • Gram stain of non-CSF body fluid
  • culture of non-CSF body fluid
  • immunohistochemical staining of skin lesion biopsy
  • echocardiography
  • joint x-ray
  • polymerase chain reaction
More investigations to consider

Treatment algorithm

INITIAL

suspected meningitis

suspected meningococcal bacteremia

ACUTE

confirmed meningococcal meningitis

confirmed meningococcal bacteremia

Contributors

Authors

Elisabeth Adderson, MD
Elisabeth Adderson

Associate Member

St. Jude Children's Research Hospital

Associate Professor of Pediatrics

University of Tennessee Health Sciences Center

Memphis

TN

Disclosures

EA declares that she has no competing interests.

Peer reviewers

Nancy Messonnier, MD, PhD

Chief

Meningitis and Vaccine Preventable Disease Branch

CDC

Atlanta

GA

Disclosures

NM declares that she has no competing interests.

Vandana Desai, MD

Professor of Pediatrics

SMIMER Hospital

Gujarat

India

Disclosures

VD declares that she has no competing interests.

Lucieni Oliveira Conterno, MD, PhD

Director

Clinical Epidemiology Unit

Marilia Medical School

Sao Paulo

Brazil

Disclosures

LOC declares that she has no competing interests.

Katherine Ajdukiewicz, MRCP

Consultant in Infectious Diseases and Tropical Medicine

Hospital for Tropical Diseases

London

UK

Disclosures

KA declares that she has no competing interests.

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