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Meningitis - meningococcal

Definition

Meningococcal meningitis is an infection that causes inflammation of the membranes covering the brain and spinal cord.

Alternative Names

Meningococcal meningitis

Causes, incidence, and risk factors

Meningococcal meningitis is caused by the bacterium Neisseria meningitidis (also known as meningococcus).

Most cases of meningococcal meningitis occur in children, from infancy to adolescence. Meningococcus is the most common cause of bacterial meningitis in children and the second most common cause of bacterial meningitis in adults.

The onset of the disease may be rapid and may start with an upper respiratory infection or sore throat. The infection occurs more often in winter or spring and may cause local epidemics at boarding schools, college dormitories, or military bases.

Risk factors include recent exposure to meningococcal meningitis and recent upper respiratory infection.

Symptoms

• Rash, pinpoint red spots (petechiae)
• Purple, bruise-like areas (purpura)
• High fever
• Severe headache
• Severe malaise (general ill feeling)
• Nausea
• Vomiting
• Stiff neck
• Sensitivity to light (photophobia)
• Mental status changes

Signs and tests

Physical examination will reveal low blood pressure, fast heart rate, stiff neck, and a possible rash.

Other tests include the following:

• White blood cell (WBC) count is higher than normal.
• Spinal tap for spinal fluid (CSF) shows increased white blood cells, low glucose, high protein.
• Special stains of spinal fluid sometimes show the meningococcus bacteria.
• CSF culture grows the meningococcus bacteria.
• Blood culture grows the meningococcus bacteria.
• CT scan of the brain is usually normal.

Treatment

Early diagnosis and treatment is extremely important to prevent serious illness or death.

Antibiotics such as ceftriaxone are prescribed and given by an IV (intravenous line). Other medicines may be used to treat the complications due to increased spinal fluid pressure.

Sometimes steroid medication is used, more often in children than adults.

People in close contact with someone with meningococcal meningitis should be given antibiotics to prevent infection. Such people include household members, roommates in dormitories, or those who come in contact with respiratory secretions of an infected person.

Expectations (prognosis)

The death rate ranges from 5% to 15%, with young children and adults over 50 having the highest risk of death.

Complications

• Brain damage
• Shock
• Increased spinal fluid pressure
• Myocarditis (inflammation of the heart)
• Hydrocephalus (blockage of spinal fluid in brain)
• Deafness
• Paralysis of various muscles
• Mental retardation

Calling your health care provider

Go to an emergency room or call the local emergency number (such as 911) if you notice symptoms of meningitis, if symptoms worsen or do not improve with treatment, or if you think you have been exposed to someone with meningitis. Meningitis can quickly become life-threatening.

Prevention

It is recommended that all family and close contacts (especially in health care or school settings) of people with this type of meningitis begin antibiotic treatment as soon as possible to prevent spread of the infection. Ask your health care provider about this during the initial diagnostic visit.

Close contacts in the same household, school, or day care center should be watched for early signs of the disease as soon as the initial case is diagnosed. Good hygiene habits such as washing hands before and after changing a diaper, or after using the bathroom, should always be implemented.

Vaccines are effective for the control of epidemics and are currently recommended for college students and military recruits, as well as travelers to certain parts of the world.

Review Date:8/15/2006
Reviewed By:Hilary M. Babcock, M.D., Medical Director of Occupational Infection Control, Barnes-Jewish and St. Louis Children's Hospitals; Instructor of Medicine, Infectious Disease Division, Washington University School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network.

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