Meningococcal disease

Meningococcal disease is an acute, potentially severe infection caused by the bacterium Neisseria meningitidis. It primarily causes meningitis and sepsis, which can lead to severe complications, like neurologic damage, loss of limbs, or death.

**Evaluation:** Anyone with suspected meningococcal disease usually presents with high fever, headache, and neck stiffness. Symptoms of meningococcemia may include petechial or purpuric rash, arthralgia, or shock-like presentation. On suspicion, immediate measures should be taken to isolate this person to avoid transmission. CALL 911 ASAP

**Diagnosis:** For diagnosis, samples of blood or cerebrospinal fluid (CSF) should be collected before starting antibiotic therapy. Quicker diagnostic tests include Gram stain and latex agglutination, but the disease's definitive diagnosis is made by culturing N. meningitidis from a sterile site (usually blood or CSF). Polymerase chain reaction (PCR) testing can also be done, which is more sensitive and can often provide faster results.

**Treatment:** Take an Ambulance to the Hospital as quickly as possible. In situations where hospital transfer will take time, it's advisable to administer a dose of a parenteral third-generation cephalosporin (like cefotaxime or ceftriaxone) before the transfer. For patients allergic to cephalosporins or with contraindications, chloramphenicol can be used as an alternative. Once the person is in a healthcare setting, the mainstay of treatment is prompt systemic antibiotic therapy, usually with a third-generation cephalosporin. Steroids like dexamethasone can be considered in cases of meningococcal meningitis. Supportive care, including management of shock, potential respiratory issues and close monitoring in ICU settings is crucial. Moreover, chemoprophylaxis for close contacts is recommended to prevent secondary cases.

After recovery, it's critical to consider immunization against N. meningitidis to prevent recurrent infection. It's also vital to provide psychological and rehabilitative support, especially in those with long-term sequelae.

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Author

Paddy Kalish OD, JD and B.Arch