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Meningitis - meningococcal

Definition

Meningococcal meningitis is an infection that results in swelling and irritation (inflammation) of the membranes covering the brain and spinal cord.

See also:

• Aseptic meningitis
• Meningitis
• Meningitis - cryptococcal
• Meningitis - Gram-negative
• Meningitis - H. influenzae
• Meningitis - pneumococcal
• Meningitis - staphylococcal
• Meningitis - tuberculous

Alternative Names

Meningococcal meningitis

Causes, incidence, and risk factors

Meningococcal meningitis is caused by the bacteria Neisseria meningitidis (also known as meningococcus).

Most cases of meningococcal meningitis occur in children and adolescents. Meningococcus is the most common cause of bacterial meningitis in children and the second most common cause of bacterial meningitis in adults.

The infection occurs more often in winter or spring. It may cause local epidemics at boarding schools, college dormitories, or military bases.

Risk factors include recent exposure to meningococcal meningitis and a recent upper respiratory infection.

Symptoms

Symptoms usually come on quickly, and may include:

• Fever and chills
• Mental status changes
• Nausea and vomiting
• Purple, bruise-like areas (purpura)
• Rash, pinpoint red spots (petechiae)
• Sensitivity to light (photophobia)
• Severe headache
• Stiff neck (meningismus)

Other symptoms that can occur with this disease:

• Agitation
• Bulging fontanelles
• Decreased consciousness
• Poor feeding or irritability in children
• Rapid breathing
• Unusual posture with the head and neck arched backwards (opisthotonos)

Signs and tests

Physical examination will show:

• Fast heart rate
• Fever
• Mental status changes
• Rash
• Stiff neck

For any patient who is suspected of having meningitis, it is important to perform a lumbar puncture ("spinal tap"), in which spinal fluid (known as cerebrospinal fluid, or CSF) is collected for testing.

Tests that may be done include:

• Blood culture
• Chest x-ray
• CSF examination for cell count, glucose, and protein
• CT scan of the head
• Gram stain, other special stains, andculture of CSF
• White blood cell (WBC) count

Treatment

Treatment with antibiotics should be started as soon as possible. Ceftriaxone is one of the most commonly used antibiotics for meningococcal meningitis. Penicillin in high doses is almost always effective, too.

If the antibiotic is not working and the health care provider suspects antibiotic resistance, chloramphenicol may be used. Sometimes corticosteroids may be used, especially in children.

People in close contact with someone who has meningococcal meningitis should be given antibiotics to prevent infection. Such people include:

• Household members
• Roommates in dormitories
• Those who come into close and long-term contact with an infected person

Support Groups

Expectations (prognosis)

Early treatment improves the outcome. The death rate ranges from 5% - 15%. Young children and adults over 50 have the highest risk of death.

Complications

• Brain damage
• Hearing loss
• Hydrocephalus
• Myocarditis
• Seizures
• Subdural effusion (buildup of fluid between the skull and brain)

Calling your health care provider

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:

• Feeding difficulties
• High-pitched cry
• Irritability
• Persistent unexplained fever

Call the local emergency number if you develop any of the serious symptoms listed above. Meningitis can quickly become a life-threatening illness.

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.

Close contacts in the same household, school, 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, such as washing hands before and after changing a diaper, or after using the bathroom.

Vaccines are effective for controlling epidemics. They are currently recommended for:

• College students in their first year living in dormitories
• Military recruits
• Travelers to certain parts of the world

References

Swartz MN. Meningitis: bacterial, viral, and other. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 437.