N.

meningitidis (MENINGOCOCCUS)

 GRAM NEGATIVE COCCUS

 Usually < 1 um in diameter
 Occurs in pairs, with adjacent sides flattened similar to kidney beans
 Non-motile, aerobic (but facultatively anaerobic), produce catalase and oxidase and may
be encapsulated
 Oxidizes glucose and maltose to acid

 Grow best on chocolate agar

 Divided into serogroups, serotypes and subtypes
 Invasive disease: meningococcemia, meningitis

Epidemiology

 Meningococci are transmitted by aerosol droplets or through contact with respiratory

secretions, such as through kissing or sharing a drinking glass.
 Respiratory infections (influenza), exposure to tobacco smoke, marijuana use, bar
patronage, binge drinking, attendance at nightclubs, and freshmen college students
living in dormitories are all associated with increased rates of meningococcal carriage or
disease.
 The highest age-incidence of meningococcal disease occurs in infants <1 yr old
 In the USA, the majority of cases of disease in the first year of life is caused by capsular
group B strains.
 After age 1 yr, disease is roughly equally distributed among group B, C, and Y strains.
 In most other industrialized countries group B strains predominate at all ages

MENINGOCOCCEMIA/MENINGITIS

 Serious or invasive disease usually is manifested as in one of two ways:

Menigococcemia or Meningitis (w/ or w/o menigococcemia)

MENINGOCOCCAL MENINGITIS

 The MOST COMMON CAUSE OF BACTERIAL MENINGITIS IN CHILDREN 1 MO TO 12 YR

OF AGE in the USA is Neisseria meningitidis.
 Fever, headache, vomiting, irritability, stiff neck and sometimes seizures
 Lethargy, obtunded
 The most common neurologic complications are hydrocephalus, cranial nerve palsy (esp
hearing loss), subdural effusion, empyema, cerebral edema, cortical vein thrombosis,
and cerebral infarction
 Hearing loss occurs in 5-10% of patients with meningitis
Meningococcemia:

 Variable
 Early in the course – URTI, coryza, pharyngitis, tonsillitis, laryngitis
 Febrile w/ headache, lethargy and vomiting
 Severe myalgia w/ muscle tenderness and joint pain may be the initial complaint
 Typical patient: short hx of fever, upper respiratory symptoms and hemorrhagic rash
 Signs of severe circulatory collapse often develop
 Purpura and shock may develop w/in hours of onset of symptoms

Skin manifestations

 Range from diffuse mottling to extensive purpuric lesions

 Petechiae or pupura present in 50-60% of patients
 Maculopapular rash alone reported in 10-13% of patients
 20-30% may have no rash at initial evaluation
 When purpura is extensive and accompanied by shock, it is referred to as purpura
fulminans
Meningococcal disease

 Case-fatality rate: 10%

 Death is associated with:
1. young age
2. absence of meningitis
3. coma
4. hypotension
5. leukopenia
6. thrombocytopenia
Sequelae (in 11-19%) include:
1. hearing loss
2. neurologic disability
3. digit or limb amputation
4. skin scarring

Diagnosis
  Definitive diagnosis of meningococcal disease is established by isolation of N.
meningitidis from a normally sterile body fluid such as blood, CSF, or synovial fluid.
 Culture results often are negative if the patient has been treated with antibiotics prior
to collection of the culture specimen.
 Isolation of the organism from the nasopharynx is not diagnostic for invasive disease.

SURVEILLANCE CASE DEFINITIONS FOR INVASIVE MENINGOCOCCAL DISEASE

CONFIRMED
A clinically compatible case and isolation of N. meningitidis from a usual sterile site (blood, CSF,
synovial fluid, pleural fluid, pericardial fluid, isolation from skin scraping of petechial or purpuric
lesions
PROBABLE
A clinically compatible case with either a positive result of antigen test or
immunohistochemistry of formalin fixed tissue or positive PCR test of blood or CSF without a
positive sterile culture site
SUSPECT
A clinically compatible case and gram negative diplococci in any sterile fluid such as CSF,
synovial fluid, or scraping from a petechial or purpuric lesion
Clinical purpura fulminans without a positive blood culture

Treatment

 Priority in management:
1. treatment of shock in meningococcemia
2. treatment of increased ICP in severe cases of meningitis
 Drug of choice: Penicillin G
 Five to 7 days duration of treatment
 Cefotaxime, ceftriaxone, ampicillin: acceptable alternatives
 Chloramphenicol if with prior anaphylactic reaction to penicillin

Prevention

 Careful observation of exposed people

 Chemoprophylaxis
 Meningococcal vaccine
 Reporting
 Counseling and public education

ANTIBIOTIC PROPHYLAXIS TO PREVENT NEISSERIA MENINGITIDIS INFECTION

DRUG DOSE DURATION

Rifampin: 2 days (4 doses)

Infants <1 mo 5 mg/kg PO every 12 hr

Children >1 mo 10mg/kg PO every 12hr

Adults 600 mg PO every 12 hr

Ceftriaxone:

Children <15 yr 125 mg IM 1 dose

Children >15 yr 250 mg IM 1 dose

Ciprofloxacin, persons >18 yr 500 mg PO 1 dose