Synonym: Neisseria meningitidis infection
Category: Childhood Infections
Agent Type: Bacteria
Acuity: Acute-Severe
Latency/Incubation: 2-10 days, usually 3-4 days;
Initial Symptoms: Meningitis: fever, headache, stiff
neck; Meningococcemia: fever, petechiae, leukocytosis; Bacteremia with
arthritis/dermatitis: joint pain, tenosynovitis, pustules; [CCDM, p. 359-66;
5MCC-2006]
Precautions: Droplet
Comments: FINDINGS: The rash is distinctive in its
early onset (within 2 hours of fever), distribution (appears on ankles,
wrists, and armpits), and character (petechial with discrete lesions 1-2 mm
in diameter on the trunk and lower extremities). The rash usually spares the
palms and soles. It may appear as papules initially, but quickly progresses
to petechiae and purpura. Ecchymoses are common at points of pressure from
clothing such as underwear and stockings. Rubella-like and vesicular rashes
have been described in some patients. Patients may have pharyngitis.
Patients with fulminant disease develop widespread ecchymoses and purpura.
In these patients the WBC count may be either high or low, and
thrombocytopenia and intravascular coagulation are common. Disseminated
intravascular coagulation (DIC) and multi-organ failure occur in
meningococcal sepsis. Signs of DIC include enlarging petechiae, oozing at IV
sites, and gingival and gastric bleeding. Other complications are pneumonia,
arthritis, myocarditis, pericarditis, pulmonary edema, and cranial nerve
palsies. Congestive heart failure caused by myocarditis is common in fatal
cases. Meningococcemia is one of the causes of postinfectious
glomerulonephritis. [CCDM, p. 359-60; Guerrant, p. 315-17;
ID, p. 58-60,
1653; PPID, p. 2592-6; Fever and rash in the immunocompetent patient.
UpToDate Online 12.2; Harrison, Table 142.1] EPIDEMIOLOGY: Meningococci in
serogroups A, B, and C cause most outbreaks. The highest incidence of
diseases occurs in children and young adults with a 5% to 10% mortality rate
despite optimal treatment. An epidemic occurs about every 8-12 years in the
meningitis belt in sub-Saharan Africa
in the dry season between January and June. [Guerrant, p. 176-7] PREVENTION:
"In rare instances, when proper precautions were not used, N.
meningitidis has been transmitted from patient to personnel, through contact
with the respiratory secretions of patients with meningococcemia or
meningococcal meningitis, or through handling laboratory specimens. . . .
Postexposure prophylaxis is advised for persons who have had intensive,
unprotected contact (i.e., without wearing a mask) with infected patients
(e.g., mouth-to-mouth resuscitation, endotracheal intubation, endotracheal
tube management, or close examination of the oropharynx of patients)."
[Guidelines for Infection Control in Health Care Personnel.
CDC. 1998]
Vaccination is recommended for travelers to the sub-Saharan "meningitis
belt" during the dry season, especially if prolonged contact with
people is anticipated. [CDC
Travel, p. 243]
Diagnostic: Culture; Positive Gram stains: 70% of
aspirants from petechial lesions and 70% of CSF samples in untreated cases;
CSF or urine antigen detection helpful when Gram stains negative; [Guerrant,
p. 318-19] PCR of CSF has >90% Sn and Sp. [PPID, p. 2506]
Scope: Global
General Symptoms: arthralgia;
fever; fever, recurrent; myalgia;
Other Findings: tachycardia; pharyngitis; hematemesis;
nausea, vomiting; leukocytosis; leukopenia; thrombocytopenia; confusion;
delirium; headache; seizure; stiff neck; conjunctivitis, acute; cyanosis,
acute; petechiae and ecchymoses; pustule; rash (exanthem); rash on palms;
skin vesicles;
Complications: acute renal failure; ARDS; arthritis;
bleeding diathesis; cranial neuropathy; erythema nodosum;
glomerulonephritis; meningitis; pericarditis; pneumonia; sepsis; shock;
stupor and coma;
Syndromes: Acute Neurological Plus Fever; Petechiae
Plus Fever; Widespread Rash Plus Fever;
Antimicrobic: Yes
Vaccine: Yes
Entry: Inhale, Skin/Eye
Source: Patient
Reservoir: Human
High-Risk Activities: Care for patients
(droplet/airborne); Fail to complete immunizations; Live together in close
quarters; Travel to endemic area; Work in a medical or research lab
