Meningococcal disease is a rapidly progressive infection caused by Neisseria meningitides, a gram-negative diplococcus bacterium. Infection begins as a nonspecific viral-like illness that rapidly evolves (within hours) into 1 of 2 main presentations: meningitis or septicemia. Most cases are acquired through exposure to asymptomatic carriers via respiratory droplets. Children aged younger than 5 years and teenagers aged 15-19 are predominantly affected.
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.
Multiple other diseases associated with vascular injury must be differentiated from meningococcal disease. Patients with congenital (clotting defects) or immune (vasculitis) causes of purpura and ecchymoses rarely have cardiovascular compromise. The large ecchymoses of meningococcal disease also tend to be well-defined, superficial, and have overlying necrosis, whereas large ecchymoses associated with clotting factor deficiencies or trauma are usually ill-defined, subcutaneous, and are not associated with necrosis. Nonspecific viral exanthems usually appear after a prodrome of several days, whereas patients with meningococcemia typically develop a rash in less than 24 hours of onset of an acute illness. Petechiae caused by coughing, crying, or vomiting are confined to the distribution of the superior vena cava (head, neck, and chest above the nipple line), whereas petechiae associated with meningococcemia are located over the entire torso and extremities.
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
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.
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.
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.