eMedicine Specialties > Neurology > Neurological Infections

Meningococcal Meningitis: Follow-up

Author: Francisco de Assis Aquino Gondim, MD, MSc, PhD, Professor Adjunto II, Departments of Physiology and Pharmacology, Neurology Residency Program Director, Faculdade de Medicina, Universidade Federal do Ceará, Brazil
Coauthor(s): Manish K Singh, MD, Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience; Sidney E Croul, MD, Director of Neuropathology, Professor, Department of Pathology and Laboratory Medicine, Medical College of Pennsylvania Hahnemann University
Contributor Information and Disclosures

Updated: Aug 11, 2009

Follow-up

Further Inpatient Care

  • Complete appropriate antimicrobial therapy course.
  • Observe the patient for any complications or neurological sequelae.

Further Outpatient Care

  • Advise any household contacts and close respiratory contacts that chemoprophylaxis agents are available to eliminate the carrier state and prevent the spread of infection.13
  • Observe patients for any late complication or neurological sequelae.

Deterrence/Prevention

  • Can be achieved by either immunoprophylaxis or chemoprophylaxis
  • Immunoprophylaxis
    • Vaccination is used for close contacts of patients with meningococcal disease due to A, C, Y, or W135 serogroups to prevent secondary cases.14
    • No effective vaccine exists to protect individuals from meningococcal meningitis caused by serogroup B.15
    • Epidemics usually spread rapidly to a peak within weeks but may last for several months in the absence of vaccination.
    • Mass immunization of selected communities using polyvalent A and C polysaccharide vaccine is a useful control measure.
  • Chemoprophylaxis
    • In general, chemoprophylaxis is not recommended during epidemics because of multiple sources of exposure and prolonged risk of exposure. Logistic problems and high cost also make this an impractical alternative.16
    • Chemoprophylaxis can be considered for people in close contact with patients in the endemic situation. It is not an effective means of interrupting transmission during an epidemic. Ciprofloxacin 500 mg in a single dose is probably the easiest option in adults. Children could receive either a single IM injection of ceftriaxone or 4 oral doses of rifampin over 2 days, according to body weight.
    • Antimicrobials commonly used for chemoprophylaxis are rifampin, ciprofloxacin, ceftriaxone, minocycline, and spiramycin.
    • When oral rifampin (4 doses in 2 d) was compared with a single IM dose of ceftriaxone for prophylaxis, follow-up cultures indicated that ceftriaxone was significantly more effective. Ceftriaxone may provide an effective alternative to rifampin for prophylaxis for people in close contact with patients with meningococcal meningitis.17
    • Sometimes, an alternative to chemoprophylaxis may be protective chemotherapy that can prevent the development of meningitis in individuals incubating the disease.

Complications

  • Early complications of bacterial meningitis include seizures, raised intracranial pressure, cerebral venous thrombosis, sagittal sinus thrombosis, and hydrocephalus. The risk of cerebral herniation from acute meningitis is about 6-8%.
  • In fulminant meningococcemia, severe DIC may develop, leading to hemorrhagic diathesis with bleeding into the lungs, urinary tract, and gastrointestinal tract. Ischemic complications of DIC also are common.
  • Infrequent suppurative complications include septic arthritis, purulent pericarditis, endophthalmitis, and pneumonia. Of survivors, 10% developed allergic complications manifested as cutaneous vasculitis or arthritis.
  • Late complications may include communicating hydrocephalus (which can present with gait difficulty, mental status changes, and incontinence) and hearing loss18 .
  • In one study, 27% of survivors experienced one or more suppurative, allergic, or neurological complications, including hearing loss, cutaneous vasculitis, and arthritis.
  • Hearing loss, noted in 9% of children, occurred significantly more often in patients with marked leukocytosis or leukopenia or with CSF leukocytosis greater than 10 X 109/L.

Prognosis

  • The prognosis for meningococcal meningitis is fair if the patient does not have focal neurological deficits and is not stuporous or comatose. The prognosis of meningococcal disease is poor when the infection has a septicemic component. Most patients with meningococcal meningitis recover completely if appropriate antibiotic therapy is instituted promptly.
  • Thrombocytopenia, a lowered coagulation index, moderate anemia (hemoglobin <11 g/dL), an obtunded mental state, and history of convulsions were reported to be poor prognostic factors. In one study, only anemia was correlated independently with fatality; the results suggested that anemia should be considered an important prognostic marker in the acute phase of meningococcal meningitis.

Patient Education

For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education articles Meningitis in Adults and Meningitis in Children.

Miscellaneous

Medicolegal Pitfalls

  • To prevent death, prompt institution of antibiotic therapy is essential when the diagnosis of bacterial meningitis is suspected.
  • Failure to make the early diagnosis of meningococcal disease and failure to provide prompt treatment are common reasons for malpractice claims.
  • In early stages, meningococcal meningitis may be misdiagnosed as a viral infection and the patient may be discharged from an emergency department.
  • The petechial rash may be difficult to recognize in dark-skinned patients.

Special Concerns

  • The Advisory Committee on Immunization Practices (ACIP) modified its guidelines after 2 studies by the Centers for Disease Control and Prevention (CDC), which were performed in 1998, identified the slightly higher risk among college freshman dormitory residents. Vaccination should be provided or made easily available to freshmen who wish to reduce their risk of disease.
  • Travelers who are planning to visit areas affected by meningococcal outbreaks are advised vaccination.
  • Oily chloramphenicol may be the drug of choice in areas with limited health facilities because a single dose of the long-acting form has been shown to be effective.
  • More information on meningococcal disease may be found at the CDC Web site.
 


More on Meningococcal Meningitis

Overview: Meningococcal Meningitis
Differential Diagnoses & Workup: Meningococcal Meningitis
Treatment & Medication: Meningococcal Meningitis
Follow-up: Meningococcal Meningitis
Multimedia: Meningococcal Meningitis
References
Further Reading
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Keywords

Neisseria meningitidis, N meningitidis, meningococcal disease, meningococci, meningococcal infections, Neisseria lactamica, N lactamica, bacterial meningitis, Waterhouse-Friderichsen syndrome, meningococcal septicemia

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Contributor Information and Disclosures

Author

Francisco de Assis Aquino Gondim, MD, MSc, PhD, Professor Adjunto II, Departments of Physiology and Pharmacology, Neurology Residency Program Director, Faculdade de Medicina, Universidade Federal do Ceará, Brazil
Francisco de Assis Aquino Gondim, MD, MSc, PhD is a member of the following medical societies: American Academy of Neurology and Movement Disorders Society
Disclosure: Boehringer-Ingelheim Honoraria Speaking and teaching

Coauthor(s)

Manish K Singh, MD, Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience
Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Association of Physicians of Indian Origin, American Headache Society, American Medical Association, and American Society of Regional Anesthesia and Pain Medicine
Disclosure: Nothing to disclose.

Sidney E Croul, MD, Director of Neuropathology, Professor, Department of Pathology and Laboratory Medicine, Medical College of Pennsylvania Hahnemann University
Sidney E Croul, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuropathologists, and Society for Neuroscience
Disclosure: Nothing to disclose.

Medical Editor

Norman C Reynolds Jr, MD, Neurologist, Veterans Affairs Medical Center of Milwaukee; Professor Medical College of Wisconsin (retired)
Norman C Reynolds Jr, MD is a member of the following medical societies: American Academy of Neurology, Association of Military Surgeons of the US, Movement Disorders Society, Sigma Xi, and Society for Neuroscience
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Florian P Thomas, MD, MA, PhD, Drmed, Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University
Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Paraplegia Society, and National Multiple Sclerosis Society
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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