Meningococcal Meningitis (Neisseria meningitidis)

#med #disease #y2023

Presentation :

Meningitis w/ fever, headache, meningismus, nausea, vomiting, photophobia.
Maculopapular or hemorrhagic petechial rash often appears soon after disease onset
Waterhouse-Friderichsen syndrome: septicemia w/ b/l adrenal hemorrhage leading to adrenal crisis profound shock, cutaneous purpura (can occur in other infxn as well)

Infection is spread by direct contact with nasal and throat secretions, so typically spreads to very close contacts: household contacts, dormitory/barrack residents (college students, military), healthcare workers, etc
Meningococci can asymptomatically colonize the nasopharynx (carrier state). Despite documented high rates of colonization (5 to 40% of healthy people), which may be transient, brief, or prolonged, transition to invasive disease is rare (< 1%)
- Nasopharyngeal carriage rates are highest in adolescents and young adults, who serve as reservoirs for transmission of N. meningitidis
Encapsulated bacteria, so asplenic patients at much higher risk

Empiric covg w/ standard meningitis abx (CTX, Vanc +/- Ampicillin for immunocompromise or age >50)
Once confirmed: Ceftriaxone 2 g IV every 12 hours is preferred treatment
- Can use Penicillin IV, however resistance is emerging, and pts require retreatment w/ CTX, cipro or rifampin to eliminate nasopharyngeal carriage
If suspicion for Waterhouse-Friderichsen syndrome w/ adrenal insufficiency, can consider hydrocortisone
- Evidence does not support usage for treatment of meningitis alone, and steroids may worsen meningococcal shock
Prophylaxis for close contacts:
- Rifampin 600mg PO q12h x4 doses
- Ceftriaxone 250mg IM x1 dose
- Ciprofloxacin/Levofloxacin 500mg PO x1d (resistance emerging; likely not ideal 1st line)
Vaccination:
- MenACWY conjugate:
  - Routine childhood vaccine (~age 11-12, booster at 16)
  - College students who missed booster at 16
  - High risk adults: anatomic/functional asplenia, HIV, complement deficiency or inhibitor use, military recrtuits, travel to endemic areas (see CDC for complete list)
- MenB:
  - High risk patients (as above)
  - If pt requests per shared decision making