Treatment and prevention of meningococcal infection
- Michael Apicella, MD
Michael Apicella, MD
- Emeritus Professor of Microbiology and Internal Medicine
- The University of Iowa
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
Neisseria meningitidis is a common cause of community-acquired bacterial meningitis in children and adults in the United States and in many other countries. (See "Epidemiology of Neisseria meningitidis infection" and "Bacterial meningitis in children older than one month: Clinical features and diagnosis", section on 'Causative organisms' and "Epidemiology of bacterial meningitis in adults".)
The clinical manifestations of meningococcal disease can be quite varied, ranging from transient fever and bacteremia to fulminant disease with death ensuing within hours of the onset of clinical symptoms. (See "Clinical manifestations of meningococcal infection".)
The treatment and prevention of meningococcal infection will be reviewed here [1-3]. The microbiology, pathobiology, epidemiology, and diagnosis of N. meningitidis infection are discussed separately. (See "Microbiology and pathobiology of Neisseria meningitidis" and "Epidemiology of Neisseria meningitidis infection" and "Diagnosis of meningococcal infection".)
Meningococcal meningitis and sepsis — Early and appropriate antibiotic treatment markedly improves the outcome of meningococcal infections. The current mortality rate of meningococcal sepsis in the United States is approximately 10 to 14 percent. The supportive data are presented below . (See 'Prognosis' below.)
Because of the importance of early antibiotic therapy, meningococcal infection should be considered in the differential diagnosis of any patient with the sudden onset of a febrile illness, especially those with petechiae and/or meningeal signs.
- Rosenstein NE, Perkins BA, Stephens DS, et al. Meningococcal disease. N Engl J Med 2001; 344:1378.
- Gardner P. Clinical practice. Prevention of meningococcal disease. N Engl J Med 2006; 355:1466.
- Stephens DS, Greenwood B, Brandtzaeg P. Epidemic meningitis, meningococcaemia, and Neisseria meningitidis. Lancet 2007; 369:2196.
- Cohn AC, MacNeil JR, Clark TA, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62:1.
- Tunkel AR, van de Beek D, Scheld WM. Acute meningitis. In: Principles and Practice of Infectious Diseases, 7th ed, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, Philadelphia 2010. p.1189.
- Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267.
- Nathan N, Borel T, Djibo A, et al. Ceftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study. Lancet 2005; 366:308.
- Grubbauer HM, Dornbusch HJ, Dittrich P, et al. Ceftriaxone monotherapy for bacterial meningitis in children. Chemotherapy 1990; 36:441.
- Marhoum el Filali K, Noun M, Chakib A, et al. Ceftriaxone versus penicillin G in the short-term treatment of meningococcal meningitis in adults. Eur J Clin Microbiol Infect Dis 1993; 12:766.
- Scheld WM, Sande MA. Bactericidal versus bacteriostatic antibiotic therapy of experimental pneumococcal meningitis in rabbits. J Clin Invest 1983; 71:411.
- Sprott MS, Kearns AM, Field JM. Penicillin-insensitive Neisseria meningitidis. Lancet 1988; 1:1167.
- Mendelman PM, Campos J, Chaffin DO, et al. Relative penicillin G resistance in Neisseria meningitidis and reduced affinity of penicillin-binding protein 3. Antimicrob Agents Chemother 1988; 32:706.
- Sáez-Nieto JA, Lujan R, Berrón S, et al. Epidemiology and molecular basis of penicillin-resistant Neisseria meningitidis in Spain: a 5-year history (1985-1989). Clin Infect Dis 1992; 14:394.
- Galimand M, Gerbaud G, Guibourdenche M, et al. High-level chloramphenicol resistance in Neisseria meningitidis. N Engl J Med 1998; 339:868.
- Lin TY, Chrane DF, Nelson JD, McCracken GH Jr. Seven days of ceftriaxone therapy is as effective as ten days' treatment for bacterial meningitis. JAMA 1985; 253:3559.
- Chippaux JP, Soula G, Campagne G, Rey M. [Optimizing the response to epidemics of meningococcal meningitis: report of a workshop of experts at CERMES (Niamey, Niger, 12th to 14th January 1998)]. Sante 1998; 8:245.
- Ellis-Pegler R, Galler L, Roberts S, et al. Three days of intravenous benzyl penicillin treatment of meningococcal disease in adults. Clin Infect Dis 2003; 37:658.
- Waage A, Brandtzaeg P, Halstensen A, et al. The complex pattern of cytokines in serum from patients with meningococcal septic shock. Association between interleukin 6, interleukin 1, and fatal outcome. J Exp Med 1989; 169:333.
- Brandtzaeg P, Ovstebøo R, Kierulf P. Compartmentalization of lipopolysaccharide production correlates with clinical presentation in meningococcal disease. J Infect Dis 1992; 166:650.
- Girardin E, Grau GE, Dayer JM, et al. Tumor necrosis factor and interleukin-1 in the serum of children with severe infectious purpura. N Engl J Med 1988; 319:397.
- Brandtzaeg P, Kierulf P, Gaustad P, et al. Plasma endotoxin as a predictor of multiple organ failure and death in systemic meningococcal disease. J Infect Dis 1989; 159:195.
- Brandtzaeg P, Mollnes TE, Kierulf P. Complement activation and endotoxin levels in systemic meningococcal disease. J Infect Dis 1989; 160:58.
- Brandtzaeg P, Bryn K, Kierulf P, et al. Meningococcal endotoxin in lethal septic shock plasma studied by gas chromatography, mass-spectrometry, ultracentrifugation, and electron microscopy. J Clin Invest 1992; 89:816.
- de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators. Dexamethasone in adults with bacterial meningitis. N Engl J Med 2002; 347:1549.
- Brouwer MC, McIntyre P, de Gans J, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2010; :CD004405.
- Belsey MA, Hoffpauir CW, Smith MH. Dexamethasone in the treatment of acute bacterial meningitis: the effect of study design on the interpretation of results. Pediatrics 1969; 44:503.
- Alberio L, Lämmle B, Esmon CT. Protein C replacement in severe meningococcemia: rationale and clinical experience. Clin Infect Dis 2001; 32:1338.
- Faust SN, Levin M, Harrison OB, et al. Dysfunction of endothelial protein C activation in severe meningococcal sepsis. N Engl J Med 2001; 345:408.
- White B, Livingstone W, Murphy C, et al. An open-label study of the role of adjuvant hemostatic support with protein C replacement therapy in purpura fulminans-associated meningococcemia. Blood 2000; 96:3719.
- de Kleijn ED, de Groot R, Hack CE, et al. Activation of protein C following infusion of protein C concentrate in children with severe meningococcal sepsis and purpura fulminans: a randomized, double-blinded, placebo-controlled, dose-finding study. Crit Care Med 2003; 31:1839.
- Wheeler JS, Anderson BJ, De Chalain TM. Surgical interventions in children with meningococcal purpura fulminans--a review of 117 procedures in 21 children. J Pediatr Surg 2003; 38:597.
- Katz AR, Chasnoff R, Komeya A, Lee MV. Neisseria meningitidis urethritis: a case report highlighting clinical similarities to and epidemiological differences from gonococcal urethritis. Sex Transm Dis 2011; 38:439.
- Conde-Glez CJ, Calderón E. Urogenital infection due to meningococcus in men and women. Sex Transm Dis 1991; 18:72.
- Flexner S. THE RESULTS OF THE SERUM TREATMENT IN THIRTEEN HUNDRED CASES OF EPIDEMIC MENINGITIS. J Exp Med 1913; 17:553.
- Goldacre MJ, Roberts SE, Yeates D. Case fatality rates for meningococcal disease in an English population, 1963-98: database study. BMJ 2003; 327:596.
- Andersen BM. Mortality in meningococcal infections. Scand J Infect Dis 1978; 10:277.
- Wolf RE, Birbara CA. Meningococcal infections at an army training center. Am J Med 1968; 44:243.
- Barquet N, Domingo P, Caylà JA, et al. Prognostic factors in meningococcal disease. Development of a bedside predictive model and scoring system. Barcelona Meningococcal Disease Surveillance Group. JAMA 1997; 278:491.
- Cartwright K, Reilly S, White D, Stuart J. Early treatment with parenteral penicillin in meningococcal disease. BMJ 1992; 305:143.
- Strang JR, Pugh EJ. Meningococcal infections: reducing the case fatality rate by giving penicillin before admission to hospital. BMJ 1992; 305:141.
- Kornelisse RF, Hazelzet JA, Hop WC, et al. Meningococcal septic shock in children: clinical and laboratory features, outcome, and development of a prognostic score. Clin Infect Dis 1997; 25:640.
- Brooks R, Woods CW, Benjamin DK Jr, Rosenstein NE. Increased case-fatality rate associated with outbreaks of Neisseria meningitidis infection, compared with sporadic meningococcal disease, in the United States, 1994-2002. Clin Infect Dis 2006; 43:49.
- Schwentker FF, Gelman S, Long PH. Landmark article April 24, 1937. The treatment of meningococcic meningitis with sulfanilamide. Preliminary report. By Francis F. Schwentker, Sidney Gelman, and Perrin H. Long. JAMA 1984; 251:788.
- Analysis of endemic meningococcal disease by serogroup and evaluation of chemoprophylaxis. J Infect Dis 1976; 134:201.
- Gilmore A, Stuart J, Andrews N. Risk of secondary meningococcal disease in health-care workers. Lancet 2000; 356:1654.
- Neal KR, Nguyen-van-Tam JS, Slack RC, et al. Seven-week interval between acquisition of a meningococcus and the onset of invasive disease. A case report. Epidemiol Infect 1999; 123:507.
- Schwartz B, Al-Tobaiqi A, Al-Ruwais A, et al. Comparative efficacy of ceftriaxone and rifampicin in eradicating pharyngeal carriage of group A Neisseria meningitidis. Lancet 1988; 1:1239.
- Zalmanovici Trestioreanu A, Fraser A, Gafter-Gvili A, et al. Antibiotics for preventing meningococcal infections. Cochrane Database Syst Rev 2013; :CD004785.
- Centers for Disease Control and Prevention (CDC). Emergence of fluoroquinolone-resistant Neisseria meningitidis--Minnesota and North Dakota, 2007-2008. MMWR Morb Mortal Wkly Rep 2008; 57:173.
- Wu HM, Harcourt BH, Hatcher CP, et al. Emergence of ciprofloxacin-resistant Neisseria meningitidis in North America. N Engl J Med 2009; 360:886.
- Enríquez R, Abad R, Salcedo C, et al. Fluoroquinolone resistance in Neisseria meningitidis in Spain. J Antimicrob Chemother 2008; 61:286.
- Chen M, Guo Q, Wang Y, et al. Shifts in the Antibiotic Susceptibility, Serogroups, and Clonal Complexes of Neisseria meningitidis in Shanghai, China: A Time Trend Analysis of the Pre-Quinolone and Quinolone Eras. PLoS Med 2015; 12:e1001838; discussion e1001838.
- Andersen J, Berthelsen L, Bech Jensen B, Lind I. Dynamics of the meningococcal carrier state and characteristics of the carrier strains: a longitudinal study within three cohorts of military recruits. Epidemiol Infect 1998; 121:85.
- Block C, Raz R, Frasch CE, et al. Re-emergence of meningococcal carriage on three-year follow-up of a kibbutz population after whole-community chemoprophylaxis. Eur J Clin Microbiol Infect Dis 1993; 12:505.
- Meningococcal meningitis and sepsis
- - Antibiotic therapy
- Empiric therapy in nonepidemic settings
- Empiric treatment during epidemics
- Duration of therapy
- - Treatment of shock
- - Supportive care
- Protein C concentrate
- Treatment of complications
- - Purpura fulminans
- - Disseminated intravascular coagulation
- - Other life-threatening complications
- Treatment of genitourinary infection
- Droplet precautions
- Antimicrobial chemoprophylaxis
- - Close contacts
- - Timing of prophylaxis
- - Regimens
- - Nasopharyngeal carriage
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