Meningococcal disease is an acute contagious illness, characterized by fever, petechial or purpuric rash, and signs of sepsis and/or meningitis.
May progress rapidly to septic shock, with hypotension, acidosis, and disseminated intravascular coagulation.
Highest rates of invasive infection are in children under 5 years of age, especially under 1 year of age, with a second peak occurring in 11- to 22-year-olds and third peak in people >65 years of age.
Diagnosis confirmed by isolation of Neisseria meningitidis from a normally sterile body site.
Confirmed meningococcal infection is treated with a third-generation cephalosporin. Where a cephalosporin is not appropriate, the choice of agent is based on the individual patient circumstances, antibiotic susceptibilities, and local availability.
Case fatality rate is 10% to 15%. Between 10% and 20% of survivors have moderate to severe sequelae, including hearing loss, motor and cognitive disabilities, blindness, or ischemic injuries of the skin or extremities.
Meningococcal infections are caused by Neisseria meningitidis, a gram-negative diplococcus that colonizes the nasopharynx. Bacteria invade the bloodstream or spread within the respiratory tract. A case is confirmed by detection of N meningitidis-specific nucleic acid (using a validated polymerase chain reaction assay) in a specimen obtained from a normally sterile site (e.g., blood or cerebrospinal fluid), or by isolation of N meningitidis from a normally sterile site or from purpuric lesions. Probable cases include those where N meningitidis antigen is detected by immunohistochemical staining on formalin-fixed tissue, or in cerebrospinal fluid by latex agglutination.
History and exam
Key diagnostic factors
- rapid onset of illness
- leg pain
- neck pain
- altered consciousness
- pallor or mottled skin
- cold hands and feet
- neck stiffness
- high-pitched cry
- Kernig sign
- Brudzinski sign
- bulging fontanel
Other diagnostic factors
- poor appetite or feeding
- nausea or vomiting
- coryza, sore throat, or cough
- respiratory distress
- 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
1st investigations to order
- blood cultures
- CBC and differential
- electrolytes, Ca, Mg, glucose
- coagulation profile (prothrombin time, INR, activated PTT, fibrinogen, fibrin degradation products)
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
- joint x-ray
- polymerase chain reaction
suspected meningococcal bacteremia
confirmed meningococcal meningitis
confirmed meningococcal bacteremia
Elisabeth Adderson, MD
St. Jude Children's Research Hospital
Associate Professor of Pediatrics
University of Tennessee Health Sciences Center
EA declares that she has no competing interests.
Nancy Messonnier, MD, PhD
Meningitis and Vaccine Preventable Disease Branch
NM declares that she has no competing interests.
Vandana Desai, MD
Professor of Pediatrics
VD declares that she has no competing interests.
Lucieni Oliveira Conterno, MD, PhD
Clinical Epidemiology Unit
Marilia Medical School
LOC declares that she has no competing interests.
Katherine Ajdukiewicz, MRCP
Consultant in Infectious Diseases and Tropical Medicine
Hospital for Tropical Diseases
KA declares that she has no competing interests.
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