Infection with the gram-negative diplococcus Neisseria meningitidis is responsible for acute meningococcemia, a severe illness that typically occurs in small epidemics. Neisseria meningitidis is transmitted from person to person by respiratory droplets, and the human nasopharynx is the only known reservoir.
The distribution is worldwide, and between 5%-10% of people in the United States are carriers at any given time. Infections are commonly caused by serogroups A, B, C, Y, and W-135 and are more common in crowded areas (such as army barracks and college dormitories), within contacts of infected family members, and in the winter and spring. Males are 3-4 times more susceptible to meningococcemia than females. Increased risk is linked to deficiencies of complement (C5-9), immunoglobulins, and properdin, asplenia, liver disease, systemic lupus erythematosus, enteropathies, and the nephrotic syndrome. Acute meningococcemia has been reported in patients coinfected with HIV and hepatitis C. In the immunocompetent, acute meningococcemia is seen in children younger than 4 years and also in teenagers (and, rarely, in persons of all ages, especially during epidemics).
The clinical picture of acute meningococcemia consists of headache, nausea, vomiting, and severe myalgias that quickly lead to obtundation and a septic-appearing patient. Patients may report a preceding upper respiratory tract infection. Petechiae are the most common cutaneous sign, seen in one-third to one-half of affected patients. Altered mental status, nuchal rigidity, seizures, and gait disturbance can also occur. In asplenic patients, fulminant meningococcemia can lead to sepsis, hypotension, shock, and death in a matter of hours. Complications of acute meningococcemia include pericarditis / myocarditis, disseminated intravascular coagulation (DIC), meningitis and permanent neurologic sequelae, septic arthritis, osteomyelitis, adrenal hemorrhage (Waterhouse-Friderichsen syndrome), gangrene, and death. The overall mortality rate is between 5%-10%; however, meningococcemia associated with DIC has a mortality rate exceeding 90%.
Chronic meningococcemia is characterized by a persistent low fever, rash, and arthralgias, and it is commonly mistaken for gonococcemia.
Rocky Mountain spotted fever (RMSF) – Petechiae and purpura appear first distally on the extremities, including the wrists, ankles, palms, and soles. Exposure to RMSF usually occurs in an endemic region.
Meningococcemia is a potentially life-threatening infection of the bloodstream. It is caused by infection with the bacteria Neisseria meningitidis. This bacteria is transmitted from person to person by respiratory droplets (coughing). The bacteria frequently live in your lungs or throat or nose without causing visible signs of illness. If the bacteria enter the bloodstream from the nose or mouth, such as when you are sick, severe complications can occur. Complications of acute meningococcemia include inflammation of the heart, problems with blood clotting, meningitis (infection of the brain and spinal cord's outer layer), permanent nerve or brain problems, infection of bone joints, infection of bones, bleeding in the adrenal glands, gangrene, and even death.
Who’s At Risk
People at increased risk include:
College freshmen living in dormitories
Military recruits
People who travel to or live in countries where meningococcal disease is common
People who have weakened immune systems
People who lack a spleen, or whose spleen does not function correctly
Signs & Symptoms
The first symptoms are usually headache, nausea, vomiting, and muscle aches. These symptoms may quickly progress to being confused, delirious, or almost comatose. Stiff neck, seizures, and trouble walking may also occur. Often, a previous cold or flu may have preceded the infection.
A rash may appear on 30% to 50% of patients. The rash consists of reddish-purple bumps and spots on the chest, hands, and feet. In severe cases, the mouth and inner surface of the eyelids may be involved.
Self-Care Guidelines
There are no self-care guidelines. Go to the emergency room immediately if you think you have symptoms of meningococcemia.
When to Seek Medical Care
Go to the emergency room immediately if you think you have symptoms of meningococcemia, including a stiff neck, fever, headache, muscle pain, nausea, and a rash with red or purple spots. Another symptom is if sunlight or bright light bothers your eyes or hurts a lot.
Treatments
Antibiotics are used to kill the bacteria that are causing the infection. The antibiotics will likely be given in the hospital through an IV for a week. In addition to antibiotics, many patients will require intensive supportive care, including IV fluids and breathing support. Close monitoring of vital signs, fluid levels, and organ function will also be performed.
Close contacts of all patients with meningococcemia should receive antibiotics within 24 hours of diagnosis of the patient's meningococcemia to prevent transmission of the bacteria.
Patient Information for Acute meningococcemia in Adult