eMedicine Specialties > Infectious Diseases > Bacterial Infections

Meningococcemia: Follow-up

Author: Mahmud H Javid, MD, Chief, Section of Infectious Diseases, Shifa Hospital, Islamabad, Pakistan
Coauthor(s): Shadab Hussain Ahmed, MD, FACP, FIDSA, MACGS, AAHIVS, Associate Professor of Clinical Medicine, State University of New York at Stony Brook; Attending Physician, Division of Infectious Diseases, Director of HIV Prevention Services, Nassau University Medical Center
Contributor Information and Disclosures

Updated: Feb 24, 2009

Follow-up

Further Inpatient Care

  • Patients with meningococcal disease should complete a course of antimicrobial therapy.
  • Manage any complications appropriately.
  • Discontinue respiratory isolation precautions after 24 hours of antibiotics.
  • Supportive care may be needed, including maintenance of fluid and electrolyte balance and vasoactive drugs in shock (eg, dopamine).
  • Monitor blood pressure, urine output, and cardiac function.
  • Closely monitor platelets, fibrin, and fibrin degradation products.
  • Some studies have shown inconclusive benefits with the use of low-dose steroids.
  • No proof shows that unconventional treatments have a significant impact on outcome in meningococcemia.
  • Currently, early recognition and appropriate treatment seem to be the optimal methods of improving outcome. However, a bactericidal/permeability-increasing (BPI) protein, a natural protein stored within the neutrophil granules that binds to and neutralizes the effects of endotoxin in vitro, in laboratory animals, and in humans, has shown some promise in clinical trials in children with severe meningococcal sepsis.
  • Activated protein C (drotrecogin alfa [Xigris]) may be used for the treatment of severe sepsis in the absence of bleeding.
  • Make sure all significant contacts of the patient have been evaluated for prophylaxis, as appropriate.

Further Outpatient Care

  • Observe for any late neurologic sequelae.
  • Pericarditis can occur while patients are recuperating from meningococcemia. Consider pericarditis in patients with fever and shortness of breath upon minimal exertion during the recovery period.
  • Late skeletal deformities are rare, but epiphyseal avascular necrosis and epiphyseal-metaphyseal defects have been described. These usually occur in the lower extremities and result in angular deformity and inequality of leg length.

Transfer

  • Once the patient is stabilized, attempt transfer to a tertiary care center because meningococcal sepsis frequently produces multisystem organ dysfunction.

Deterrence/Prevention

  • Meningococcal polysaccharide vaccine is used for immunization in individuals older than 2 years. The CDC has issued new (2007) guidelines for the use of meningococcal vaccinations. The tetravalent vaccine contains A, C, Y, and W135 polysaccharides. It is safe and effective. It is useful in aborting outbreaks caused by serogroups represented in the vaccine and therefore should be used in their control. Administer in the following groups:
    • Immunization of military recruits
    • Routine immunization of travelers to areas where epidemics occur (eg, as per Saudi requirements, individuals traveling for the hajj pilgrimage)
    • Immunization of individuals with complement deficiencies or asplenia
  • To decrease the risk of infection in the clinical setting, staff caring for patients with known or suspected meningococcal infections should wear masks in addition to standard precautions.
  • Antibiotic prophylaxis may be needed if intensive direct contact with patients has occurred in the absence of appropriate precautions.
    • Prophylaxis aims to produce long-term (ie, 3-4 wk) eradication of meningococci from the nasopharynx using short-term antibiotics.
    • Treatment must be initiated immediately if prophylaxis is deemed necessary. The tetravalent vaccine must be administered to all intimate contacts of the index patient.

Complications

Prognosis

  • Patients with terminal complement component deficiency have a more favorable prognosis.
  • A fatal outcome is associated with properdin deficiencies.
  • Coagulopathy with partial thromboplastin time greater than 50 seconds or fibrinogen concentration less than 150 µg/dL indicates a poor prognosis.

Miscellaneous

Medicolegal Pitfalls

  • In nonoutbreak situations, health care workers who are asymptomatic carriers of N meningitidis do not need to be identified, treated, or removed from patient care.
  • Make sure that the local department of health is notified of suspected and/or proven cases of meningococcal infection to assist in evaluation of close contacts and prophylaxis.
  • Watch for pericarditis and tamponade in the recovery period.

Special Concerns

  • Chemoprophylaxis should be administered to intimate household, daycare center, and nursery school contacts of sporadic cases. Vaccinate household and other intimate contacts.
  • The safety of the meningococcal polysaccharide vaccine in pregnant women has not been evaluated, and it should be avoided unless the risk of infection is high. The vaccine is also not routinely indicated for health care workers in the United States. The vaccine, similar to other polysaccharide vaccines, is not immunogenic in children younger than 2 years because of unknown reasons.
 


More on Meningococcemia

Overview: Meningococcemia
Differential Diagnoses & Workup: Meningococcemia
Treatment & Medication: Meningococcemia
Follow-up: Meningococcemia
Multimedia: Meningococcemia
References
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References

  1. MacLennan J, Kafatos G, Neal K, Andrews N, Cameron JC, Roberts R. Social behavior and meningococcal carriage in British teenagers. Emerg Infect Dis. Jun 2006;12(6):950-7. [Medline].

  2. Plant L, Sundqvist J, Zughaier S, Lövkvist L, Stephens DS, Jonsson AB. Lipooligosaccharide structure contributes to multiple steps in the virulence of Neisseria meningitidis. Infect Immun. Feb 2006;74(2):1360-7. [Medline].

  3. Davison KL, Ramsay ME. The epidemiology of acute meningitis in children in England and Wales. Arch Dis Child. Aug 2003;88(8):662-4. [Medline].

  4. Wilder-Smith A. W135 meningococcal carriage in association with the Hajj pilgrimage 2001: the Singapore experience. Int J Antimicrob Agents. Feb 2003;21(2):112-5. [Medline].

  5. Wilder-Smith A, Barkham TM, Earnest A, Paton NI. Acquisition of W135 meningococcal carriage in Hajj pilgrims and transmission to household contacts: prospective study. BMJ. Aug 17 2002;325(7360):365-6. [Medline].

  6. Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet. Jun 30 2007;369(9580):2196-210. [Medline].

  7. Moura AS, Pablos-Méndez A, Layton M, Weiss D. Epidemiology of meningococcal disease, New York City, 1989-2000. Emerg Infect Dis. Mar 2003;9(3):355-61. [Medline].

  8. Feldman HA. Meningococcal infections. Adv Intern Med. 1972;18:117-40. [Medline].

  9. Guarner J, Greer PW, Whitney A, Shieh WJ, Fischer M, White EH, et al. Pathogenesis and diagnosis of human meningococcal disease using immunohistochemical and PCR assays. Am J Clin Pathol. Nov 2004;122(5):754-64. [Medline].

  10. Fernández-Rodríguez A, Alcalá B, Alvarez-Lafuente R. Real-time polymerase chain reaction detection of Neisseria meningitidis in formalin-fixed tissues from sudden deaths. Diagn Microbiol Infect Dis. Apr 2008;60(4):339-46. [Medline].

  11. Centers for Disease Control and Prevention (CDC). Update: Guillain-Barré syndrome among recipients of Menactra meningococcal conjugate vaccine--United States, June 2005-September 2006. MMWR Morb Mortal Wkly Rep. Oct 20 2006;55(41):1120-4. [Medline].

  12. Alberio L, Lammle B, Esmon CT. Protein C replacement in severe meningococcemia: rationale and clinical experience. Clin Infect Dis. May 1 2001;32(9):1338-46. [Medline].

  13. Barquet N, Domingo P, Cayla JA. Oral Antibiotics and Outcome in Meningococcemia. Arch Intern Med. Jul 24 2000;160(14):2220-2223. [Medline].

  14. Brasier AR, Macklis JD, Vaughan D, et al. Myopericarditis as an initial presentation of meningococcemia. Unusual manifestation of infection with serotype W135. Am J Med. Mar 23 1987;82(3 Spec No):641-4. [Medline].

  15. Busund R, Straume B, Revhaug A. Fatal course in severe meningococcemia: clinical predictors and effect of transfusion therapy. Crit Care Med. Nov 1993;21(11):1699-705. [Medline].

  16. Davison KL, Andrews N, White JM, Ramsay ME, Crowcroft NS, Rushdy AA. Clusters of meningococcal disease in school and preschool settings in England and Wales: what is the risk?. Arch Dis Child. Mar 2004;89(3):256-60. [Medline].

  17. Deutch S, Labouriau R, Schønheyeder HC, Ostergaard L, Nørgård B, Sørensen HT. Crowding as a risk factor of meningococcal disease in Danish preschool children: a nationwide population-based case-control study. Scand J Infect Dis. 2004;36(1):20-3. [Medline].

  18. Drapkin MS, Wisch JS, Gelfand JA, et al. Plasmapheresis for fulminant meningococcemia. Pediatr Infect Dis J. Jun 1989;8(6):399-400. [Medline].

  19. Dull PM, Abdelwahab J, Sacchi CT, et al. Neisseria meningitidis serogroup W-135 carriage among US travelers to the 2001 Hajj. J Infect Dis. Jan 1 2005;191(1):33-9. [Medline].

  20. El Ahmer OR, Essery SD, Saadi AT, et al. The effect of cigarette smoke on adherence of respiratory pathogens to buccal epithelial cells. FEMS Immunol Med Microbiol. Jan 1999;23(1):27-36. [Medline].

  21. Faust SN, Levin M, Harrison OB, et al. Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med. Aug 9 2001;345(6):408-16. [Medline].

  22. Gjini AB, Stuart JM, Lawlor DA, Cartwright KA, Christensen H, Ramsay M. Changing epidemiology of bacterial meningitis among adults in England and Wales 1991-2002. Epidemiol Infect. Jun 2006;134(3):567-9. [Medline].

  23. Grob H, Frei R, Tyndall A, Itin PH. [Chronic meningococcemia--a rare, but characteristic disease picture]. Schweiz Med Wochenschr. Dec 12 1998;128(50):1988-93. [Medline].

  24. Hardy DJ, Bartholomew WR, Amsterdam D. Pathophysiology of primary meningococcal pericarditis associated with Neisseria meningitidis group C. A case report and review of the literature. Diagn Microbiol Infect Dis. Mar 1986;4(3):259-65. [Medline].

  25. Heyderman RS, Ben-Shlomo Y, Brennan CA, Somerset M. The incidence and mortality for meningococcal disease associated with area deprivation: an ecological study of hospital episode statistics. Arch Dis Child. Nov 2004;89(11):1064-8. [Medline].

  26. Hyszczak R, Bartold KP, Eggleston D. Gangrene associated with meningococcemia. AJR Am J Roentgenol. Jul 1988;151(1):203-4. [Medline].

  27. Kirsch EA, Barton RP, Kitchen L, Giroir BP. Pathophysiology, treatment and outcome of meningococcemia: a review and recent experience. Pediatr Infect Dis J. Nov 1996;15(11):967-78; quiz 979. [Medline].

  28. Leclerc F, Leteurtre S, Cremer R, et al. Do new strategies in meningococcemia produce better outcomes?. Crit Care Med. Sep 2000;28(9 Suppl):S60-3. [Medline].

  29. Marotto MS, Marotto PC, Sztajnbok J, Seguro AC. Outcome of acute renal failure in meningococcemia. Ren Fail. Nov 1997;19(6):807-10. [Medline].

  30. Ni H, Knight AI, Cartwright K, et al. Polymerase chain reaction for diagnosis of meningococcal meningitis. Lancet. Dec 12 1992;340(8833):1432-4. [Medline].

  31. Pathan N, Hemingway CA, Alizadeh AA, et al. Role of interleukin 6 in myocardial dysfunction of meningococcal septic shock. Lancet. Jan 17 2004;363(9404):203-9. [Medline].

  32. Pecoul B, Varaine F, Keita M, et al. Long-acting chloramphenicol versus intravenous ampicillin for treatment of bacterial meningitis. Lancet. Oct 5 1991;338(8771):862-6. [Medline].

  33. Pereiro I, Diez-Domingo J, Segarra L, et al. Risk factors for invasive disease among children in Spain. J Infect. May 2004;48(4):320-9. [Medline].

  34. Platonov AE, Beloborodov VB, Vershinina IV. [Clinical features of meningococcal infection in subjects with deficient terminal components of complement]. Ter Arkh. 1999;71(11):14-8. [Medline].

  35. Riedo FX, Plikaytis BD, Broome CV. Epidemiology and prevention of meningococcal disease. Pediatr Infect Dis J. Aug 1995;14(8):643-57. [Medline].

  36. Rosenstein NE, Perkins BA, Stephens DS, et al. Meningococcal disease. N Engl J Med. May 3 2001;344(18):1378-88. [Medline].

  37. Salzman MB, Rubin LG. Meningococcemia. Infect Dis Clin North Am. Dec 1996;10(4):709-25. [Medline].

  38. Schaller RT Jr, Schaller JF. Surgical management of life-threatening and disfiguring sequelae of fulminant meningococcemia. Am J Surg. May 1986;151(5):553-6. [Medline].

  39. Schlossberg D. Fever and rash. Infect Dis Clin North Am. Mar 1996;10(1):101-10. [Medline].

  40. Singh J, Arrieta AC. Management of meningococcemia. Indian J Pediatr. Oct 2004;71(10):909-13. [Medline].

  41. Tappero JW, Reporter R, Wenger JD, et al. Meningococcal disease in Los Angeles County, California, and among men in the county jails. N Engl J Med. Sep 19 1996;335(12):833-40. [Medline].

  42. van Deuren M, van Dijke BJ, Koopman RJ, et al. Rapid diagnosis of acute meningococcal infections by needle aspiration or biopsy of skin lesions. BMJ. May 8 1993;306(6887):1229-32. [Medline].

  43. Vienne P, Ducos-Galand M, Guiyoule A, et al. The role of particular strains of Neisseria meningitidis in meningococcal arthritis, pericarditis, and pneumonia. Clin Infect Dis. Dec 15 2003;37(12):1639-42. [Medline].

  44. Welch SB, Nadel S. Treatment of meningococcal infection. Arch Dis Child. Jul 2003;88(7):608-14. [Medline].

  45. White B, Livingstone W, Murphy C, et al. An open-label study of the role of adjuvant hemostatic support with protein C replacement therapy in purpura fulminans-associated meningococcemia. Blood. Dec 1 2000;96(12):3719-24. [Medline].

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Further Reading

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Keywords

meningococcemia, Waterhouse-Friderichsen syndrome, Neisseria meningitidis infection, N meningitidis, meningitis with meningococcemia, acute meningococcal infection, meningitis, meningococci, fulminant meningococcemia, meningococci A, meningococci B, meningococci C, meningococci Y, meningococci W-135, immunoglobulin G2 subclass deficiency, purpura fulminans, meningococcal disease, occult meningococcemia, chronic meningococcemia, meningococcal sepsis

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Contributor Information and Disclosures

Author

Mahmud H Javid, MD, Chief, Section of Infectious Diseases, Shifa Hospital, Islamabad, Pakistan
Mahmud H Javid, MD is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Shadab Hussain Ahmed, MD, FACP, FIDSA, MACGS, AAHIVS, Associate Professor of Clinical Medicine, State University of New York at Stony Brook; Attending Physician, Division of Infectious Diseases, Director of HIV Prevention Services, Nassau University Medical Center
Shadab Hussain Ahmed, MD, FACP, FIDSA, MACGS, AAHIVS is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society
Disclosure: Nothing to disclose.

Medical Editor

Mary Nettleman, MD, MS, Chair, Department of Medicine, Michigan State University
Mary Nettleman, MD, MS is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Aaron Glatt, MD, Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, New Island Hospital
Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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