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Meningococcal meningitis — Clinical Guidelines

Overview

Meningococcal meningitis and sepsis are severe infections caused by Neisseria meningitidis, characterized by rapid progression and potential for significant morbidity and mortality, including purpura fulminans, disseminated intravascular coagulation (DIC), and multiorgan failure 1 3 9.

Diagnosis

Clinical Presentation: Fever, purpuric rash (petechiae and ecchymoses), and may lack classic meningeal signs in sepsis 1.

Laboratory Tests: Peripheral blood smear showing evidence of DIC, thrombocytopenia, and elevated inflammatory markers 1.

Imaging: Not typically required for diagnosis but may show signs of organ dysfunction 7.

Culture: Blood and cerebrospinal fluid cultures are definitive but may take time 1 13.

Management

First-Line Treatments:

- Antibiotics: Early administration of broad-spectrum antibiotics (e.g., ceftriaxone) is crucial 1 13.

Adjunctive Therapies:

- Activated Protein C: Associated with rapid clinical improvement in septic shock 6. - Protein C Concentrate: Effective in treating purpura fulminans 11. - Therapeutic Filtration: Early implementation has been linked to reduced mortality 10.

Special Populations

Pediatrics: Higher risk of severe complications including DIC and organ failure 1 13.

Comorbidities: Secondary asplenia post-severe meningococcal sepsis increases susceptibility to other bacterial infections 2.

Adrenal Insufficiency: Rarely observed but can occur, warranting cortisol monitoring 14.

Key Recommendations

Prompt Antibiotic Therapy: Initiate broad-spectrum antibiotics immediately upon suspicion of meningococcal sepsis (Evidence: Strong 1 13).

Monitor for DIC and Organ Dysfunction: Regularly assess for disseminated intravascular coagulation and multiorgan failure, utilizing laboratory markers like platelet count and base excess (Evidence: Moderate 3 9).

Consider Activated Protein C in Severe Cases: Use activated protein C in patients with septic shock and multiple organ failure (Evidence: Moderate 6).

Early Therapeutic Interventions: Implement early therapeutic filtration in suspected meningococcal septic shock to potentially reduce mortality (Evidence: Moderate 10).

Vaccination for High-Risk Travelers: Vaccinate travelers to endemic regions, especially children and young adults with prolonged close contact with local populations (Evidence: Expert opinion 8).

References

1 Mutreja D, Moorchung N, Manasa SJ, Varghese J. Fatal meningococcal septicemia without meningeal signs, contribution of the peripheral smear in diagnosis: Report of a case. Indian journal of pathology & microbiology 2018. link 2 Castillo-Campos L, Bachiller-Carnicero L, Megía-Sevilla MJ, González-Tomé MI. Secondary asplenia as a complication of severe Meningococcal Sepsis. BMJ case reports 2017. link 3 Holinski P, Joffe AR. A simple meningococcal sepsis prognostic score: focusing on the human animal. Critical care (London, England) 2013. link 4 Chaibou MS, Bako H, Salisou L, Yaméogo TM, Sambo M, Kim SH et al.. Monitoring adverse events following immunization with a new conjugate vaccine against group A meningococcus in Niger, September 2010. Vaccine 2012. link 5 Mayer CA, Neilson AA. Meningococcal meningitis - prevention in travellers. Australian family physician 2010. link 6 Thomas GL, Wigmore T, Clark P. Activated protein C for the treatment of fulminant meningococcal septicaemia. Anaesthesia and intensive care 2004. link 7 Luyt DK, Pridgeon J, Brown J, Peek G, Firmin R, Pandya HC. Extracorporeal life support for children with meningococcal septicaemia. Acta paediatrica (Oslo, Norway : 1992) 2004. link 8 . When to vaccinate travellers against meningococci. Prescrire international 2003. link 9 Zeerleder S, Zürcher Zenklusen R, Hack CE, Wuillemin WA. Disseminated intravascular coagulation in meningococcal sepsis. Case 7. Hamostaseologie 2003. link 10 Pearson G, Khandelwal PC, Naqvi N. Early filtration and mortality in meningococcal septic shock?. Archives of disease in childhood 2000. link 11 Rintala E, Seppälä OP, Kotilainen P, Pettilä V, Rasi V. Protein C in the treatment of coagulopathy in meningococcal disease. Critical care medicine 1998. link 12 D'Amelio R, Biselli R. The role of complement in anti-bacterial defence. Annali italiani di medicina interna : organo ufficiale della Societa italiana di medicina interna 1994. link 13 McManus ML, Churchwell KB. Coagulopathy as a predictor of outcome in meningococcal sepsis and the systemic inflammatory response syndrome with purpura. Critical care medicine 1993. link 14 McWhinney PH, Patel A, Walker E. Adrenal failure in fulminant meningococcal septicaemia: a clinical reality. Scandinavian journal of infectious diseases 1990. link 15 Guéret P, Buchalter M. Cardiac tamponade in a case of meningococcal meningitis. British heart journal 1986. link 16 Schifferli JA, Blanc E. Partial lipodystrophy, meningococcal meningitis and nephritis. Dermatologica 1986. link 17 Mason W, Igdaloff S, Friedman R, Wright HT. Meningococcal sepsis with endophthalmitis. American journal of diseases of children (1960) 1979. link

Meningococcal meningitis