Dermatologic Manifestations of Meningococcemia Treatment & Management
- Author: Elizabeth L Tanzi, MD; Chief Editor: Dirk M Elston, MD more...
Medical Care
- The most important measure in treating meningococcemia is early detection and rapid administration of antibiotics. Penicillin G is the antibiotic of choice for susceptible isolates. A third-generation cephalosporin (eg, cefotaxime, ceftriaxone) can be used initially in septic patients while the diagnosis is being confirmed or in countries such as the United Kingdom or Spain, where penicillin-resistant strains of N meningitidis have been isolated.[6]
- Intensive supportive care is required for patients with fulminant meningococcemia. Components of treatment include antibiotic therapy, ventilatory support, inotropic support, and intravenous fluids. Central venous access facilitates the administration of massive amounts of volume expanders and inotropic medications needed for adequate tissue perfusion. If disseminated intravascular coagulation (DIC) is present, fresh frozen plasma may be indicated. Treatment is individualized depending on the severity of hemodynamic compromise of the patient.
- Many experimental and alternate therapies have been tried with varying success.[7] Currently under study are treatments to inhibit inflammatory mediators (eg, monoclonal antibodies to endotoxin, tumor necrosis factor, interleukin 1, interleukin 6, and interferon-gamma). Anecdotal reports show removal of inflammatory mediators by dialysis may offer some benefit. Fibrinolytic treatment using recombinant tissue plasminogen activator or the administration of highly purified protein C concentrate may prove to be helpful adjuncts to conventional therapy to improve tissue perfusion in the presence of DIC.[8]
- Several clinical guideline summaries related to meningococcal disease are available, as follows:
- American Academy of Pediatrics Committee on Infectious Diseases - Prevention and control of meningococcal disease: recommendations for use of meningococcal vaccines in pediatric patients[9]
- Centers for Disease Control and Prevention Advisory Committee on Immunization Practices - Revised recommendations of the Advisory Committee on Immunization Practices to Vaccinate all Persons Aged 11-18 Years with Meningococcal Conjugate Vaccine[10]
- Scottish Intercollegiate Guidelines Network -Management of invasive meningococcal disease in children and young people. A national clinical guideline[11]
Surgical Care
Patients who survive the initial acute phase of fulminant meningococcemia are at increased risk for serious complications as a result of poor tissue perfusion.[12]
- Early in the course of tissue injury, conservative therapy is recommended until a distinct line of demarcation is apparent between viable and nonviable tissue.
- Once the patient is stable, debridement of all necrotic tissue is essential and may necessitate extensive removal of skin, subcutaneous tissue, and muscle.
- Large defects may be covered using microvascular free flaps or skin grafts.
- The use of artificial skin can spare the patient immediate use of autograft sites, which frequently are limited.[13]
- Avoid amputation whenever useful function of a limb can be salvaged.
- Poor tissue perfusion may also lead to dental complications that require extensive extraction of severely affected teeth.[14]
Consultations
- Infectious disease specialist - To assist in management and provide guidance in antimicrobial therapy
- Preventive medicine specialist - To evaluate the community risk associated with an index case and initiate reporting to local and regional health authorities if indicated
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