Meningococcemia Workup

  • Author: Mahmud H Javid, MBBS; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Oct 26, 2011
 

Laboratory Studies

  • Definitive diagnosis of meningococcal infection requires culture of meningococci from blood, spinal fluid, joint fluid, or, occasionally, from skin lesions.
  • Cultures produce transparent, nonpigmented colonies that are oxidase positive and nonhemolytic.
    • The sensitivity of blood culture is 60%-80% in untreated patients.
    • Cerebrospinal fluid (CSF) culture yields a sensitivity of up to 70% in untreated patients.
  • Polymorphonuclear leukocyte levels are usually elevated, but they may be within the reference range or low.
  • Thrombocytopenia may be present.
  • In meningitis, the CSF can be turbid in appearance, with elevated pressures and proteins, and low glucose levels. In very early infections, CSF examination results may be normal.
    • CSF Gram stain yields a sensitivity of approximately 50% in patients with meningococcal meningitis. It can have a higher yield than blood cultures.
    • Detection of meningococcal capsular polysaccharide in CSF may be used for rapid diagnosis. It is sensitive for A and C polysaccharides.
  • Gram-negative diplococci may be observed in punch biopsy and needle aspiration specimens of skin lesions or buffy coat preparations. Gram-negative diplococci may also be recovered from joint fluid. Findings on Gram stains of skin lesions remain positive for up to 2 days after the start of antibiotics and form a rapid means of diagnosis, including when meningitis is not present and when spinal fluid culture findings are negative owing to the administration of antibiotics. See the image shown below. Gram-negative intracellular diplococci. Courtesy PGram-negative intracellular diplococci. Courtesy Professor Chien Liu.
  • Meningococcal polymerase chain reaction (PCR) is a rapid method for diagnosing CSF infection.[13] It may not be available commercially in the United States but has been used extensively in the United Kingdom. PCR of spinal fluid yields a sensitivity and specificity of more than 90% in the diagnosis of meningococcal meningitis. It is useful when antibiotics have been administered and can be used to rapidly type strains in developing epidemics. Diagnosis and serogrouping of N meningitidis infection can also be performed on formalin-fixed tissue samples using immunohistochemical analysis and PCR.[14, 15]
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Imaging Studies

  • Chest radiography is useful to evaluate for pneumonia and acute respiratory distress syndrome.
  • Echocardiography can be used to evaluate for myocardial dysfunction and pericarditis.
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Other Tests

  • With serogrouping, polysaccharide antigens on the capsule are identified by a slide agglutination test using polyclonal antibodies.
  • With serotyping and serosubtyping, outer membrane proteins (PorB and PorA) can be identified by an enzyme linked immunosorbent assay (ELISA) using monoclonal antibodies.
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Procedures

  • Lumbar puncture is used to test for meningitis.
    • Appearance
    • Measurement of pressure
    • Stain and culture of fluid
    • WBC count and differential
    • Total protein level
    • Glucose level
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Staging

Evaluate for evidence of other end-organ damage (eg, kidney or hepatic failure) with appropriate blood tests.

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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mahmud H Javid, MBBS  Consultant, Infectious Diseases, Shifa International Hospital, Islamabad, Pakistan

Mahmud H Javid, MBBS 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, AAHIVS  Associate Professor of Clinical Medicine, The School of Medicine at Stony Brook University Medical Center; Adjunct Clinical Associate Professor, Department of Medicine, New York College of Osteopathic Medicine of New York Institute of Technology; Attending Physician, Department of Medicine, Division of Infectious Diseases, Director of HIV Prevention Services, Administrative HIV Designee, Nassau University Medical Center

Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and International AIDS Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary D Nettleman, MD, MS, MACP  Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly 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.

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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Dorsum of the hand showing a petechial rash. Courtesy of Professor Chien Liu.
Petechial lesions on the palm. Courtesy of Professor Chien Liu.
Petechial rash on lower extremities. Courtesy of Professor Chien Liu.
Conjunctival petechiae. Courtesy of Professor Chien Liu.
Gram-negative intracellular diplococci. Courtesy Professor Chien Liu.
 
 
 
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