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- Caused by Neisseria meningitidis in the blood, which results in a broad spectrum of clinical manifestations
- Bacteremia without sepsis: Meningococcal bacteremia rarely occurs without sepsis.
- Bacteremia without meningitis: Patient is acutely ill and may have skin manifestations (rashes, petechiae, and ecchymosis) and hypotension.
- Bacteremia with meningitis:
- Predominant clinical picture of meningitis: Sudden onset of fever, nausea, vomiting, headache, decreased ability to concentrate, and myalgias
- Disease progression is usually quite rapid with a transition from health to severe disease in a matter of hours.
- Skin manifestations and hypotension may also be present:
- A petechial rash appears as discrete lesions 1–2 mm in diameter, most frequently on the trunk and lower portions of the body and will be seen in >50% of patients on presentation.
- Purpura fulminans is a severe complication of meningococcal disease and occurs in up to 25% of cases. It is characterized by acute onset of cutaneous hemorrhage and necrosis due to vascular thrombosis and disseminated intravascular coagulopathy.
- The US mortality rate is 0.5–1.1/100,000, or ∼13%:
- 11–19% of survivors suffer serious sequelae, including deafness, neurologic deficit, or limb loss.
- Disease is seasonal, with cases peaking in December and January.
- Annually, ~1,000 cases of invasive meningococcal disease occur in the US (1):
- Among adolescents and young adults, 14–24, occurrence is 20%.
- Among infants <1 year, occurrence is 16%.
- Age: 3 months–1 year
- Late complement component deficiency (C5, C6, C7, C8, or C9)
- Asplenia (1)
- Close contacts (e.g., household, nurseries, day care, dormitories, military barracks)
- Exposure to active and passive tobacco smoke (1)
Late complement component deficiency has an autosomal-recessive inheritance.
- 2 vaccines are currently licensed for use in the US. Each contains antigens to serogroups A, C, Y, and W-135. Neither provides immunity against serotype B, which is responsible for 1/3 of US cases (2):
- Meningococcal polysaccharide vaccine (MPSV4): Recommended for patients ≥55 with elevated risk (1):
- Meningococcal conjugate vaccine (MCV4): Recommended for patients 2–55 (1)
- Protective levels of antibody are achieved in ∼7–10 days after primary immunization (2).
- Vaccine is recommended for all persons 11–18 and persons 19–55 at increased risk for the disease:
- Guillain-Barré syndrome has been associated with the MCV4 vaccine, so a personal history of Guillain-Barré is a relative contraindication for receiving this vaccine.
- CDC International Travel Advisory:
- Vaccine is required by the Government of Saudi Arabia for Hajj pilgrims >2.
- The vaccine should be given to travelers to sub-Saharan Africa (“meningitis belt”) during dry season.
- Neisseria meningitidis, a gram-negative diplococcus with at least 13 serotypes
- Major serogroups in the US: B, C, Y, and W-135:
- Serogroup B is the predominant cause of meningococcemia in children <1 year.
- Serogroup C is the most common cause of cases in the US.
- Serogroup Y is the predominant cause of meningococcemia in the elderly (2).
- Major serogroups worldwide are A, B, C, Y, and W-135:
- W-135 is the major cause of disease in the “meningitis belt” of sub-Saharan Africa.