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?
- Is it possible to prevent meningococcemia?
- Where can people find more information on meningococcemia?
- What research is being done on meningococcemia?
What is the prognosis of meningococcemia?
Despite antibiotic therapy and intensive-care monitoring, meningococcemia still has overall case fatality rates of 10%-15% in the United States. Up to 19% have long-term complications from meningococcal infections. These complications could include amputation of limbs due to ischemia or low blood pressure, adrenal insufficiency from adrenal hemorrhage, neurological disabilities, arthritis, need for skin grafting, and others.
Is it possible to prevent meningococcemia?
There are several ways to prevent meningococcemia. Infected people are contagious and will be placed in private isolation rooms in the hospital. Health-care workers will wear masks when entering the room. Isolation duration varies but is at least 24 hours after the start of intravenous antibiotics.
People who have come into close contact with an infected patient should strongly consider taking antibiotics to reduce the risk of disease, which is known as prophylactic treatment. Physicians may have patients take prophylactic antibiotics such as rifampin (Rifadin) or ciprofloxacin (Cipro) in pill form. Sometimes a shot of ceftriaxone is used. The choice of antibiotic is based on the age of the patient, resistance patterns in the community, and whether the person is pregnant or not. Close contact usually means household contacts, day-care or child-care contacts, or those who have been exposed to potentially infected saliva in the week before the patient got sick. Routine patient care does not warrant prophylaxis in health-care workers, unless the worker has had very close contact with respiratory secretions such as when giving mouth-to-mouth resuscitation or inserting a breathing tube. Prophylaxis should be given as soon as possible after the exposure but certainly within two weeks of the event. The antibiotics help eliminate carriage of the bacteria and may also be used in the final step of treatment for infected patients. People who have been exposed to N. meningitidis should be monitored for 10 to 14 days to make sure they do not develop symptoms.
For caretakers and health-care workers, frequent hand washing is recommended to minimize the transfer of infected secretions to the mouth or nose. In the hospital, patients with meningococcemia are placed in private rooms and staff will wear surgical masks when approaching the patient.
There is an effective and safe vaccine to protect against most serogroups of meningococcus that cause meningococcemia. Unfortunately, no effective vaccine exists for serogroup B in the U.S. For the other major disease-causing serogroups (A, C, Y, W135), there are two types of vaccines available in the United States. The choice of vaccine depends on the age of the patient. Vaccine side effects are usually mild, consisting of a sore arm. Allergic reactions may occur but are very rare.
The vaccine is recommended for all children starting at 11 years of age. A booster dose should be given at 16 years of age. Teens who are 16 years of age or older and have never been vaccinated need only a single dose. The vaccine may be required for admission to college, and students should have received the vaccine less than five years before starting college. In adults, vaccination is recommended for those who are military recruits, college students living in dormitories, individuals with missing or damaged spleens, have certain immune deficiencies in the complement system, those traveling to areas where the disease is common, and scientists performing research on the bacteria. In some situations where an individual remains at high risk, revaccination is performed after five years.
Vaccination is also recommended for infants and children less than 11 years of age if they are at high risk. These risk factors are similar to those listed above such as those with complement deficiencies, splenectomy or functional asplenism, outbreak, or travel to high-risk areas.
Outbreaks of meningococcemia or meningococcal disease occur sporadically around the world but occur more predictably in sub-Saharan Africa. Travelers visiting these areas should be vaccinated. As mentioned above, Saudi Arabia requires proof of vaccination for travelers during the Hajj.
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