Meningococcemia (cont.)
Mary D. Nettleman, MD, MS, MACP
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
In this Article
- Meningococcemia facts
- What is meningococcemia?
- What causes meningococcemia?
- What are risk factors for meningococcemia?
- What are symptoms and signs of meningococcemia?
- How is meningococcemia diagnosed?
- What is the treatment for meningococcemia?
- What is the prognosis of meningococcemia?
- Can meningococcemia be prevented?
- Where can people find more information on meningococcemia?
- What research is being done on meningococcemia?
How is meningococcemia diagnosed?
Patients are often presumptively diagnosed with meningococcemia from the patient's history and physical exam, but a definitive diagnosis is usually sought. This presumptive diagnosis is important because treatment needs to be started as soon as possible if meningococcemia is suspected. Meningococcemia is diagnosed by culturing N. meningitidis from a sample of blood. The bacteria grow in one to two days in most cases, and biochemical methods are used to identify them as N. meningitidis. Samples of the growth can also be stained and examined under the microscope to detect the characteristic double kidney bean appearance of the bacteria, although the biochemical tests are needed for definitive diagnosis.
In some instances, skin scrapings from pustular lesions can reveal the organisms; other investigators have occasionally used a PCR test to detect N. meningitidis.
What is the treatment for meningococcemia?
Intravenous antibiotics are needed to treat meningococcemia. Most strains remain sensitive to older treatments such as ampicillin (Omnipen, Polycillin, Principen) or penicillin G (Bicillin L-A), although a few strains are resistant and require therapy with a newer agent such as ceftriaxone (Rocephin). The laboratory will test the bacteria to see which antibiotics will work best, but treatment will need to start before the results of these antimicrobial sensitivity tests come back. Therefore, doctors usually select antibiotics that are known to work against most strains of N. meningitidis.
Blood pressure is supported with intravenous fluids or medications. Meningococcemia often requires treatment in an intensive-care unit.
Recently, a newer agent called drotrecogin alpha (Xigris) has shown some efficacy in reducing complications of severe bloodstream infections, although only a small number of patients with meningococcemia have been tested. This agent has the potential to cause serious bleeding, so it should not be used in patients who are already at increased risk for bleeding. Thus, use of drotrecogin alpha remains controversial.
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