Definition of Meningococcal Meningitis Meningococcal meningitis is a severe bacterial infection of the bloodstream and meninges (a thin lining covering

the brain and spinal cord). The microorganism that causes this condition is called meningococcus or Neisseria meningitidis (N. meningitidis). Description of Meningococcal Meningitis The meningococcus bacteria is spread by direct close contact with nose or throat discharge of an infected person. Many people carry this particular bacteria in their nose and throat without any signs of illness, while others may develop serious symptoms. Causes and Risk Factors of Meningococcal Meningitis Meningococcal meningitis occurs as a communicable disease between humans. It is often found in young military recruits living together, or among college students living in close quarters in dormitories. When the cerebrospinal fluid is invaded by this blood-borne organism. Originating in the respiratory tract, the meningococcus bacteria travels, via the blood, into the cerebrospinal fluid (the watery liquid that surrounds the brain and spinal cord). During infection, the bacterium releases a toxin into the fluid causing an inflammatory reaction. If the bacteria invades the blood it can lead to arthritis, heart infections and pneumonia. If it damages the nerves leading into the brain it could cause hearing loss, learning disabilities, motor impairment or mental retardation. Symptoms of Meningococcal Meningitis The most common symptoms of meningococcal meningitis are:

Confusion Symptoms may also include:

• • • • • • • • • • • •

Fever Chills Headache Vomiting Stiff neck Rash

Diagnosis of Meningococcal Meningitis A medical history and physical examination are useful but not specific enough to make the diagnosis. Typically a lumbar puncture (also called a spinal tap) must be done. This procedure is done by injecting local anesthetic (numbing medicine) into the skin of the lower back, then inserting a hollow needle into the lower part of the spinal canal and withdrawing some cerebrospinal fluid. The fluid is then stained and cultured to determine the causative organism and to look for signs of infection (white blood cells, bacteria, protein). Cultures of blood, sputum and urine will also be obtained. In all patients with suspected meningitis, chest films and CT scans of the brain are done to look for other sources of infections and to rule out other diagnoses. Treatment of Meningococcal Meningitis Bacterial meningitis is a medical emergency. Every hour of delay in starting antibacterial (antibiotic) therapy increases the risk of complications and permanent neurological damage. Treatment with intravenous antibiotics (such as penicillin G or ceftriaxone) should be started immediately, in some cases even before the lumbar puncture. The regimen of intravenous antibiotics may be continued for up to 7-10 days. Postexposure Prevention Household members, close friends at school and at home with intensive exposure, and - if the child attends child care - all preschool children who are cared for in the same room, should receive an antibiotic such as rifampin, ceftriaxone or ciprofloxacin as soon as possible (preferably within 24 hours of the diagnosis) as a preventive measure. Prevention of Meningococcal Meningitis A vaccine called meningococcal polysaccharide is used to prevent infection by certain groups of meningococcal bacteria. The vaccine works by causing the body to produce its own antibodies against the disease. This vaccine only applies to the Groups A, C, Y and W-135 of the meningococcal bacteria. The vaccine will not protect against Group B. The vaccine is recommended for persons who:

• • •

Are exposed to areas where the epidemic is occurring and the cases are due to Groups A, C, Y, and W-135 Are military recruits Have no spleen

the meninges. Infected fluid from the meninges then passes into the spinal cord, causing symptoms including stiff neck, fever andrashes. The meninges (and sometimes the brain itself) begin to swell, which affects the central nervous system. Even with antibiotics, approximately 1 in 10 victims of meningococcal meningitis will die; However, about as many survivors of the disease lose a limb or their hearing, or suffer permanent brain damage.[3] The sepsis type of infection is much more deadly, and results in a severe blood poisoningcalled meningococcal sepsis that affects the entire body. In this case, bacterial toxins rupture blood vessels and can rapidly shut down vital organs. Within hours, patient's health can change from seemingly good to mortally ill.[4] The N. meningitidis bacterium is surrounded by a slimy outer coat that contains diseasecausing endotoxin. While many bacteria produce endotoxin, the levels produced by meningococcal bacteria are 100 to 1,000 times greater (and accordingly more lethal) than normal. As the bacteria multiply and move through the bloodstream, it sheds concentrated amounts of toxin. The endotoxin directly affects the heart, reducing its ability to circulate blood, and also causes pressure on blood vessels throughout the body. As some blood vessels start to hemorrhage, major organs like the lungs and kidneys are damaged. Patients suffering from meningococcal disease are treated with a large dose of antibiotic. The systemic antibiotic flowing through the bloodstream rapidly kills the bacteria but, as the bacteria are killed, even more toxin is released. It takes up to several days for the toxin to be neutralized from the body by using continuous liquid treatment and antibiotic therapy.[5] There are many mental signs of meningococcal such as paranoia and other mental instabilities. [edit]Meningitis The patient with meningococcal meningitis typically presents with high fever, meningism (stiff neck),Kernig's sign, severe headache, vomiting, purpura, photophobia, and sometimes chills, altered mental status, or seizures. Diarrhea or respiratory symptoms are less common. Petechiae is often also present, but does not

Meningococcal disease describes infections caused by the bacterium Neisseria meningitidis (also termed meningococcus). It carries a high mortality rate if untreated. Whilst best known as a cause of meningitis, widespread blood infection (sepsis) is more damaging and dangerous. Meningitis and Meningococcemia are major causes of illness, death, and disability in both developed and under developed countries worldwide. The disease's host/pathogen interaction is not fully understood. The pathogen originates harmlessly in a large number of the general population, but thereafter can invade the blood stream and the brain, causing serious illness. Over the past few years, experts have made an intensive effort to understand specific aspects of meningococcal biology and host interactions, however the development of improved treatments and effective vaccines will depend on novel efforts by workers in many different fields.[1] The incidence of endemic meningococcal disease during the last 13 years ranges from 1 to 5 per 100,000 in developed countries, and from 10 to 25 per 100,000 in developing countries. During epidemics the incidence of meningococcal disease approaches 100 per 100,000. There are approximately 2,600 cases of bacterial meningitis per year in the United States, and on average 333,000 cases in developing countries. The case fatality rate ranges between 10 and 20 per cent.[2] While Meningococcal disease is not as contagious as the common cold (which is spread through casual contact), it can be transmitted through saliva and occasionally through close, prolonged general contact with an infected person. Pathogenesis Meningococcal disease causes life-threatening meningitis and sepsis conditions. In the case of meningitis, bacteria attack the lining between the brain and skull called

Seizures Coma Inability to completely extend the legs Stiffness in knees and hips

• • •

Are age two (2) or older Are susceptible to certain conditions that may cause meningococcal meningitis Are living in, working in, or visiting an area where there is a high incidence of meningococcal infection

Shock The symptoms may appear 2 to 10 days after exposure, but usually within 5 days.

Under certain circumstances if unvaccinated healthcare personnel cannot get vaccinated and who have intensive contact with oropharyngeal secretions of infected patients and who do not use proper precautions should receive antiinfective prophylaxis against meningococcal infection (i. chills.Y and W-135 vaccines for all young adolescents at 11–12 years of age and all unvaccinated older adolescents at 15 years of age. Although safety and efficacy of the vaccine have not been established in children younger than 2 years of age and under outbreak control. the first symptoms include fever. Anyone with symptoms of meningococcal meningitis should receive intravenus antibiotics pending results of lumbar puncture. unlike Yellow fever. meningitides or to patients with meningococcal disease. Prevention The most important form of prevention is a vaccine against N. N.C. a condition where blood starts to clot throughout the body.the membranes that line the brain and spinal cord. Typically. DIC also causes bleeding. Myocarditis can be a complication of meningococcemia and can be contributive to shock seen in this form of disease. Mencevax of GlaxoSmithKline and Nm Vac4-A/C/Y/W-135 (has not been licensed in the US) of JN-International Medical Corporation are the commonly used vaccines. meningitidis can infect a variety of sites. as delay in treatment worsens the prognosis. 200 years after the discovery of bacterial meningitis. Western Europe.C. Americas.[17][22] [edit]Military recruits Because the risk of meningococcal disease is increased among military recruits.[6] [edit]Other types As with any gram negative bacterium. meningitidis is highly endemic or epidemic are at risk of exposure should receive primary immunization against meningococcal disease. usually accompanying disseminated infection. With prompt treatment with penicillin or chloramphenicol. polysaccharide vaccines are an acceptable alternative for adults in this age group if the conjugated vaccine is unavailable. Any individual 11– 55 years of age who wishes to reduce their risk of meningococcal disease may receive Meningitis A. the unconjugated vaccine can be considered.[25] [26][27] . seizures.[14][15] [edit]Vaccinations [edit]Children Children 2–10 years of age who are at high risk for meningococcal disease such as certain chronic medical conditions and travel to or reside in countries with hyperendemic or epidemic meningococcal disease should receive primary immunization.[23] [edit]Travelers and tourists Immunization against meningococcal disease is not a requirement for entry into any country.. so its absence should not be used against the diagnosis of meningococcal disease. nausea. HIV-infected individuals 11–55 years of age may receive primary immunization with the conjugated vaccine.Y and W-135 vaccines have not been evaluated in HIV-infected individuals to date. when the clotting factors are used up. Although conjugate vaccines are the preferred meningococcal vaccine in adolescents 11 years of age or older. Later symptoms include septic shock. polysaccharide vaccines are an acceptable alternative if the conjugated vaccine is unavailable. like many gramnegative blood infections. Vaccines offer significant protection from three to five years (plain polysaccharide vaccine Menomune.[22] Vaccination against meningitis do not decrease CD4+ T-cell counts or increase viral load in HIV-infected individuals and there has been no evidence that the vaccines adversely affect survival. causing the characteristic purpuric rash.e. Vaccines are currently available against four of the five strains. Mencevax and NmVac-4) to more than eight years (conjugate vaccine Menactra). Travelers to or residents of areas where N. anxiety. [18][24] [edit]HIV-infected individuals HIV-infected individuals are likely to be at increased risk for meningococcal disease. Although conjugate vaccines are the preferred meningococcal vaccine in adults 55 years of age or younger. and malaise. B. Although the risk for meningococcal disease for is similar to 18–24 years of age that for the general population of similar age. This is a multilobar. and multiple organ dysfunction syndrome. Acute respiratory distress syndrome and altered mental status may also occur. Other forms of disease can rarely be seen. Meningococcal pneumonia can appear during influenza pandemics and in military camps. diarrhea. HIVinfected individuals who wish to reduce their risk of meningococcal disease may receive primary immunization against meningococcal disease. stiff neck.Y and W-135 vaccines and those older than 55 years of age. The college students consider vaccination against meningococcal disease to reduce their risk for the disease and stated that college healthcare providers should take a proactive role in providing information about meningococcal disease to students and their parents. Y and W135 are responsible for virtually all cases of the disease in humans. sometimes associated with septic shock. at least initially. hypotension. Hospital Infection Control Practices Advisory Committee (HICPAC) recommendations regarding immunization of health-care workers that routine vaccination of health-care personnel is recommended. similar to those of influenza. [edit]Meningitis Meningococcal meningitis is a consequence of bacteria entering the cerebrospinal fluid (CSF) and irritating the meninges . 2-day regimen of oral rifampin or a single dose of IM ceftriaxone or a single dose of oral ciprofloxacin). [edit]Meningococcemia This section requires expansion. Meningococcal sepsis has a higher mortality rate then meningococcal meningitis.[citation needed] [edit]Types of infection [edit]Meningococcemia Meningococcemia. like osteomyelitis. Only Saudi Arabia require that travelers to their country for the annual Hajj and Umrah pilgrimage have a certificate of vaccination against meningococcal disease issued not more than 3 years and not less than 10 days before arrival in Saudi Arabia. polysaccharide vaccines should be used for primary immunization in this group. but the risk of neurologic sequelae is much lower. SubSaharan Africa. UK and Ireland face multifarious challenges. Different countries have different strains of the bacteria and therefore use different vaccines. myalgia. Pericarditis can appear. the prognosis is excellent. meningitidis can be seen.Y and W-135 vaccines.endophthalmitis and urethrit is.[17][18][20][20] [edit]Adults College Students who plan to live in dormitories receive primary immunization with Meningitis A. meningitidis.Menomune of SanofiAventis. arthralgia. Since safety and efficacy of conjugate vaccines in adults older than 55 years of age have not been established to date.[22] Although efficacy of Meningitis A. Five serogroups. purpura. C. A..[16] [17][18][19] [edit]Children and adolescents 11 years of age or older It is recommended that primary immunization against meningococcal disease with Meningitis A. Symptoms of meningococcemia are.[17][18] [edit]Medical staff and laboratory personnel Health care people should receive routine immunization against meningococcal disease for laboratory personnel who are routinely exposed to isolates of N. and a vaccine against the B strain is in development. Laboratory personnel and medical staff are at risk of exposure to N. rapidly evolving pneumonia. can cause disseminated intravascular coagulation (DIC). either as a septic pericarditis with grave prognosis or as a rective pericarditis in the wake of meningitis or septicaemia. Menactra. cyanosis. meningitidis..C.always occur. Pharyngitis and conjunctivitis can also appear and can constitute the portal of entry for the bacterium.C. petechiae. sometimes causingischemic tissue damage. headache. [21] Routine primary immunization against meningococcal disease is recommended for most adults live in endemic areas and planning to travel such areas.. all military recruits routinely receive primary immunization against the disease. Septic arthritis due to N.

which is the period of communicability. or severe systemic infection with circulatory collapse and disseminated intravascular coagulation (DIC). penicillin has remained the drug of choice for the treatment of meningococcal meningitis.[31] Additionally. the urogenital tract and anal canal. inotropic support. Close contacts are defined as those persons who could have had intimate contact with the patient’s oral secretions such as through kissing or sharing of food or drink. developed countries. treatment must be started immediately and should not be delayed while waiting for investigations. E. Organisms replicate rapidly. cefotaxime or ceftriaxone. all close contacts with the infected person can be offered antibiotics to reduce the likelihood of the infection spreading to other people. Bacteria can be found for 2-4 eMedicine days in the nose and pharynx and for up to 24 hours after starting antibiotics. Within 24 hours. but that number increases to as many as 60-80% of members of closed populations (eg. aerobic. C. W-135. The natural habitat and reservoir for meningococci is the mucosal surfaces of the human nasopharynx and. Once in hospital. After adherence to the nasopharyngeal mucosa. Background Meningococcal meningitis (International Classification of Disease-9 [ICD-9] code: 036. Supportive measures include IV fluids. thus reinforcing natural immunity. Later complications are: deafness.[30] By preventing susceptible contacts from acquiring infection by directly inhibiting colonization. Approximately 5-10% of adults are asymptomatic nasopharyngeal carriers.g.[28] [29] Meningococcal infection is usually introduced into a household by an asymptomatic person. Treatment with penicillin may not eradicate the bacteria from the nasopharyngeal carriers. and then an urgent transfer to hospital for further care. reaching infants usually after one or more other household members have been infected. Meningococcal disease most likely occurs within a few days of acquisition of a new strain. Early complications include: raised intracranial pressure. X. vaccination cannot prevent early onset disease in these contacts and usually is not recommended following sporadic cases of invasive meningococcal disease. Steroid therapy may help in some adult patients. N meningitidis enters the bloodstream. Meningococcemia leads to diffuse vascular injury. lasting neurological deficits. dopamine or dobutamine and management of raised intracranial pressure. meningococcal colonization of mucosal surfaces leads to subclinical infection or mild symptoms. encapsulated diplococcus that grows best on enriched media such as Mueller-Hinton or chocolate agar. Invasive disease depends on host factors. In most cases. Meningococci that elaborate a capsule can lead to invasive disease. and the first clinical trials using high doses of intravenous penicillin as monotherapy for the treatment of meningitis were reported in 1950. Meningitis occurs sporadically throughout the year. Adhesins and endotoxins also enhance their pathogenic potential. entire family live in a single room of a house. e. the disease transmission to other susceptible person cannot be prevented. B.[edit]Household and other close contacts of individuals with invasive meningococcal disease Protective levels of anticapsular antibodies are not achieved until 7–14 days following administration of a meningococcal vaccine. Chemoprophylaxis is commonly used to those close contacts who are at highest risk of carrying the pathogenic strains. the antibiotics of choice are usually IV broad spectrum 3rd generationcephalosporins. reduced IQ. At least 13 serogroups have been described: A. and Z. In approximately 10-20% of cases. and phagocytic cells or may multiply. it has been postulated that close contact is necessary for transmission.0) has been recognized as a serious problem for almost 200 years. However. They differ in their agglutination reactions to sera directed against polysaccharide antigens. can reduce the incidence of infection by limiting exposure. In the vascular compartment. C. complement. Benzylpenicillin and chloramphenicol are also effective. The incubation period averages 3-4 days (range 1-10 days). e. which is characterized by endothelial necrosis. K. It was first identified definitely by Vieusseux in Geneva in 1805. seizures. Colonization withN meningitidis gradually replaces the nonpathogenic bacteria and induces antibodies to the infecting strain. B. asymptomatic carriers are usually the source of transmission. at 37° and in an atmosphere of 5-10% carbon dioxide. Subsequently. close to vessels and local immune cells.was isolated first in 1887. Carriage then spreads through the household. Since then. H. The causative organism.g. The modes of infection include direct contact or respiratory droplets from the nose and throat of infected people. Complications following meningococcal disease can be divided into early and late groups. and gangrene leading to amputations. and since the organism has no known reservoir outside of man. Disease is most likely to occur in infants and young children who lack immunity to the strain of organism circulating and who subsequently acquire carriage of an invasive strain. The first successful treatment of meningitis with intravenous and intrathecal penicillin was reported in 1944. Meningococci comprise numerous serogroups that are based on the composition of their polysaccharide capsular antigens. L. initiating the bacteremic phase. basic hygienemeasures.1 For related information. D. The importance of the carrier state in meningococcal disease is well known. intraluminal thrombosis. susceptibility peaks at age 6-12 months and decreases again after colonization of closely related nonpathogenic bacteria such as Neisseria lactamica that have surface antigens in common with virulent strains. Vaccinations are the only answer for reducing the transmission of the Meningococcal disease. Neisseria meningitidis. Pathophysiology N meningitidis is a gram-negative. or W-135. to a lesser extent. I.[32] [33] [edit]Treatment and prognosis When meningococcal disease is suspected. meningococci are transported to membrane-bound phagocytic vacuoles. More than 99% of meningococcal infections are caused by serogroups A. In developed countries the disease transmission usually occurs in day care. they can be seen in the submucosa. but is unlikely to affect long term outcomes. they may be killed by bactericidal antibodies. This can lead to systemic infection in the form of bacteremia. Y. When a case is confirmed. rifampin-resistant strains have been reported and the indiscriminate use of antibiotics contributes to this problem. disseminated intravascular coagulation. military recruits in camps). Therefore. oxygen. see article Meningococcal Infections. blindness. group A was more prevalent. before that. particularly among infants and young children. such as handwashing and not sharing drinking cups. in sub-Saharan Africa and other under developed countries. circulatory collapse and organ failure. Systemic disease appears with the development of meningococcemia and usually precedes meningitis by 24-48 hours. Infants are protected from meningococcal disease for the first few months of life by transferred maternal antibodies and low rate of meningococcal acquisition. metastatic infection that commonly involves the meninges (see Media file 3). and perivascular hemorrhage. Serogroups B and C have caused most cases of meningococcal meningitis in the United States since the end of World War II. . Unlike. 29E. The capsule protects them from desiccation and from host immune mechanisms. Treatment in primary care usually involves prompt intramuscular administration of benzylpenicillin. before the development of specific serum antibodies. Invasive disease occurs if no protective bactericidal antibodies are mounted against the infecting strain. schools and large gatherings where usually disease transmission could occur. Because the meningococcal organism is transmitted by respiratory droplets and is susceptible to drying. Meningococcal disease still is associated with a high mortality rate and persistent neurological defects.

If coma is present. since individuals from different areas have different strains of meningococci. Fibroblasts also proliferate. Seizures occur in 40% of children with meningitis. even when the combination of convulsive status epilepticus and fever is present. the subarachnoid and ventricular exudate contains large numbers of neutrophils and necrotic debris. coma. which usually points to disease progression. focal neurological deficits. Occasionally. • • • • • • • • • • Imaging Studies . when it usually is associated with multiorgan failure (ie. fever. legs. HIV infection. the prognosis is poor. component of the alternative pathway of complement). and headache and neck stiffness may not be present. imaging is an important cause of delay of therapy. A petechial or purpuric rash usually is found on the trunk. Waterhouse-Friderichsen syndrome). Patients older than 30 years were noted to have petechiae (62%) less frequently than younger patients (81%). In infants. Lethargy or drowsiness frequently is reported. and stiff neck.Dysfunctional properdin (ie. Clinical History o o Projectile vomiting may occur. However. subdural effusion.10 PCR of the nspA gene was also reported to be a fast diagnostic test. and fever. vomiting. Brudzinski sign). and cerebral ischemia. which may include culture of CSF and blood specimens. Typical CSF abnormalities in meningitis include the following: o Increased opening pressure (>180 mm water) o Pleocytosis of polymorphonuclear leukocytes (WBC counts between 10 and 10. MRI with contrast is preferred to CT scan because MRI better demonstrates meningeal lesions. which is characterized by rapid circulatory collapse and a hemorrhagic rash. its sensitivity is not affected by prior antibiotic treatment. Gram stain is positive in 70-90% of untreated cases. Intracellular and extracellular bacteria can be demonstrated. Periodic complexes and periodic lateralizing epileptiform discharges (PLEDs) may be suggestive of encephalitis caused by herpes simplex virus. the number of mononuclear leukocytes increases.9 The IS1106 PCR is a rapid and sensitive test for confirmation of the diagnosis. delirium. are needed for identification of N meningitidis and the serogroup of meningococci. CT scan findings are usually normal. In bacterial meningitis. choroid plexitis. The risk of invasive disease is higher in the first few days after exposure to a new strain. Contrast enhances the cisterns. CNS complications that can be visualized by MRI include hydrocephalus. The Waterhouse-Friderichsen syndrome may develop in 10-20% of children with meningococcal infection. and empyema. the classic signs and symptoms of acute bacterial meningitis may not be present. typically during the first few days.11 • • Other Tests An electroencephalogram (EEG) study is sometimes useful to document irritable electrical patterns that may predispose the patient to seizures. Individuals acquire the infection if they are exposed to virulent bacteria and have no protective bactericidal antibodies. clinical signs of nuchal rigidity (eg. nausea. Purulent material usually is observed in the choroid plexus. as well as for determining its susceptibility to antibiotics. o Irritability is a common presenting feature. and DIC. cerebral edema. Stupor or coma is less common. lethargy. Crowding living conditions also facilitate disease spread. More specialized laboratory tests. and they predominate by the end of the first week. With time.6 purpura fulminans. The exudate extends along the perivascular spaces into the cortex and cerebral cortex. Patients also may complain of skin rash. N meningitides. Indications for performing CT scan prior to lumbar puncture include altered level of consciousness. fever. predominantly neutrophils) o Decreased glucose concentration (<45 mg/dL) o Increased protein concentration (>45 mg/dL) Gram stain and culture of CSF identify the etiological organism. o Elderly patients are prone to have an altered mental state and a prolonged course with fever. Smoking and concurrent viral infection of the upper respiratory tract diminish the integrity of the respiratory mucosa and increase the likelihood of invasive disease. photophobia. and change in mental status. it is on the palms and soles. Neurological signs include nuchal rigidity. and/or focal or generalized seizure activity. or convulsions. mucous membranes. and conjunctivae. neck stiffness. o Most adult patients have an altered mental state. ventriculitis (especially in neonates). stiff neck may be absent. Workup Laboratory Studies • Perform a neuroimaging study (either MRI or CT scan) prior to lumbar puncture in all patients in whom meningitis is suspected. functional or anatomical asplenia. septic shock. This syndrome is characterized by large petechial hemorrhages in the skin and mucous membranes. and congenital complement deficiencies also predispose individuals to meningococcal disease. the illness may have an insidious onset. aqueductal obstruction. Polymerase chain reaction (PCR)8 may be used to complement standard laboratory procedures for the diagnosis of meningococcal meningitis. Kernig sign. only 70% of the patients had the classic triad of fever. If the presence of rash was added. papilledema. 89% of the patients had 2 of the 4 features. and culture results are positive in as many as 80% of cases. and extension of enhancing subarachnoid exudate deep into the sulci may be seen in severe cases. The rash may progress to Laboratory examination of the cerebrospinal fluid (CSF) usually confirms the presence of meningitis.000 cells/µL. A more severe but less common form of meningococcal disease is meningococcal septicemia. • • Physical • • In a 2008 published cohort study from Netherlands (the Meningitis Cohort Study). Histologic Findings During the first few days. In children. The clinical pattern of bacterial meningitis is quite different in young children: Bacterial meningitis usually presents as a subacute infection that progresses over several days.5 Meningococcal meningitis is characterized by acute onset of intense headache. T1 may show obliterated cisterns. Strokes can be seen with the development of vasculitis and cerebritis. The majority of seizures have a focal onset.

Adults aged 18-50 years and individuals with basilar skull fracture should be treated with a thirdgeneration cephalosporin. ciprofloxacin). these delays appear to be physician generated and. Chemoprophylactic antimicrobials most commonly used to eradicate meningococci include rifampin. since delay in treatment is associated with adverse clinical outcome.) The infection occurs more often in winter or spring. the beginning of sterilization pneumococcus by 4 hours. This pattern is common in autopsied cases. empyema. To prevent serious neurological morbidity and death. meningitis due to N meningitidis may be impossible to differentiate from other types of meningitis. Treatment Medical Care Meningococcal disease is potentially fatal and always should be viewed as a medical emergency. and ceftriaxone are the antimicrobials used to eradicate meningococci from the nasopharynx. especially in those with meningitis caused by Haemophilus influenzae. prompt institution of antibiotic therapy is essential when the diagnosis of bacterial meningitis is suspected. the antibiotic regimen can be changed appropriately. In general. bruise-like areas (purpura) Rash. Meningococcus is the most common cause of bacterial meningitis in children and the second most common cause of bacterial meningitis in adults. A recent study has suggested that at least in children. Person-to-person transmission can be interrupted by chemoprophylaxis. Surgical Care of Therapy should be changed to ceftriaxone (or cefotaxime) if the isolate is resistant to penicillin. Admission to a hospital is necessary. in which spinal fluid . it consists of ampicillin plus cefotaxime or an aminoglycoside. Unresponsiveness to penicillin has not been observed in the United States. It may be used in children. especially in high-risk cases. empirical treatment with an antibiotic with effective CNS penetration should be based on age and underlying disease status. Causes Meningococcal meningitis is caused by the bacteria Neisseria meningitidis (also known as meningococcus). the adjunctive use of dexamethasone may be beneficial. but the addition of ampicillin is required in patients in whom a Listeria species pathogen is suspected (eg. Symptoms Symptoms usually come on quickly. Once the organism is identified. CSF sterilization may occur more rapidly after initiation of parenteral antibiotics than previously suggested. patients older than 50 years. Other symptoms that can occur with this disease: • • • Meningococcal meningitis is an infection that results in swelling and irritation (inflammation) of the membranes covering the brain and spinal cord. Rifampin. Most cases of meningococcal meningitis occur in children and adolescents. college dormitories. quinolones (eg. pinpoint red spots (petechiae) Sensitivity to light (photophobia) Severe headache Stiff neck (meningismus) • • • In infants younger than 4 weeks. Thrombosis of small vessels leads to infarction. Long delays may occur in the emergency department before initiation of antibiotics in patients with suspected bacterial meningitis. neonates). draw blood for culture and begin administration of empiric antibiotics. and hydrocephalus.12 In children and adults. to a great extent. which eradicates the asymptomatic nasopharyngeal carrier state. as follows: • • Institute antimicrobial therapy as soon as possible after the lumbar puncture is performed. • • • • • • Agitation Bulging fontanelles Decreased consciousness Poor feeding or irritability in children Rapid breathing Unusual posture with the head and neck arched backwards (opisthotonos) Exams and Tests Physical examination will show: • Once the accurate diagnosis of meningococcal meningitis is established. Routine testing for susceptibility of meningococcal isolates is not necessary. In adults with suspected bacterial meningitis. with complete sterilization of meningococcus within 2 hours and • • • • • • • • Fever and chills Mental status changes Nausea and vomiting Purple. • • • • • Fast heart rate Fever Mental status changes Rash Stiff neck For any patient who is suspected of having meningitis. Medication At presentation. quinolones. and may include: Surgical interventions may be necessary for the management of complications such as subdural effusions. Currently. potentially avoidable. The use of dexamethasone in the management of bacterial meningitis in adults remains controversial. If imaging studies are indicated before lumbar puncture. Administration of empiric antibiotics is unlikely to decrease diagnostic sensitivity if CSF is tested for bacterial antigens early in the course of the illness. Risk factors include recent exposure to meningococcal meningitis and a recent upper respiratory infection. appropriate changes can be made. or military bases. and spiramycin.Inflammatory cells infiltrate leptomeningeal and cortical arteries and veins and accumulate in the intima. Antibiotics Penicillin is the drug of choice for the treatment of meningococcal meningitis and septicemia. It may cause local epidemics at boarding schools. it is important to perform a lumbar puncture ("spinal tap"). the recommended initial empiric therapy consists of third-generation cephalosporins. Infants aged 4-12 weeks should be treated with ampicillin plus a thirdgeneration cephalosporin. (Also included in this category are ceftriaxone. a third-generation cephalosporin or ampicillin plus chloramphenicol is an appropriate combination. In children aged 12 weeks to 18 years. Thus. Standard empirical therapy varies according to age. penicillin is the drug of choice for the treatment of meningococcal meningitis and septicemia. minocycline. and sulfonamides. unless the patient does not exhibit appropriate clinical response. while individuals older than 50 years should be treated with ampicillin plus a third-generation cephalosporin.

Sometimes corticosteroids may be used. such as washing hands before and after changing a diaper. cell count. Prevention All family and close contacts (especially in health care or school settings) of people with this type of meningitis should begin antibiotic treatment as soon as possible to prevent spread of the infection. Ask your health care provider about this during the first visit. Vaccines are effective for controlling epidemics. Tests that may be done include: • • • Myocarditis Seizures Subdural effusion (buildup of between the skull and brain) fluid • • • • • • Blood culture Chest x-ray CSF examination for glucose. chloramphenicol may be used. especially in children.(known as cerebrospinal fluid. Young children and adults over 50 have the highest risk of death. school. Ceftriaxone is one of the most commonly used antibiotics for meningococcal meningitis.15%. other andculture of CSF special stains. too. Close contacts in the same household. or day care center should be watched for early signs of the disease as soon as the first case is diagnosed. Always use good hygiene habits. Penicillin in high doses is almost always effective. Such people include: • • • • Feeding difficulties High-pitched cry Irritability Persistent unexplained fever Call the local emergency number if you develop any of the serious symptoms listed above. If the antibiotic is not working and the health care provider suspects antibiotic resistance. The death rate ranges from 5% . Possible Complications • • • College students in their first year living in dormitories Military recruits Travelers to certain parts of the world • • • Brain damage Hearing loss Hydrocephalus . When to Contact a Medical Professional Call the local emergency number (such as 911) or go to an emergency room if you suspect meningitis in a young child who has the following symptoms: White blood cell (WBC) count Treatment Treatment with antibiotics should be started as soon as possible. or after using the bathroom. or CSF) is collected for testing. They are currently recommended for: • • • Household members Roommates in dormitories Those who come into close and longterm contact with an infected person Outlook (Prognosis) Early treatment improves the outcome. Meningitis can quickly become a lifethreatening illness. People in close contact with someone who has meningococcal meningitis should be given antibiotics to prevent infection. and protein CT scan of the head Gram stain.