Meningococcemia

Meningococcemia is a topic covered in the Select 5-Minute Pediatrics Topics.

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Basics

Description

  • A systemic infection with the bacterium Neisseria meningitidis, a gram-negative diplococcus that is relatively fastidious. Despite treatment with appropriate antibiotics, this disease may have a fulminant course (i.e., significant complications within hours of presentation) with a high likelihood of mortality.
  • 13 serogroups have been described on the basis of capsular polysaccharide antigens; serotypes B, C, and Y account for most of the cases in the United States. Serogroup Y accounted for 30% of cases between 1996 and 1998.

General Prevention

  • Isolation of the hospitalized patient; hospitalized patients require respiratory isolation until 24 hours after initiation of appropriate antibiotic therapy.
  • Exposed contacts, including household, day care, and nursery school, should receive the following:
    • Rifampin, 10 mg/kg (maximum 600 mg) PO q12h for 4 doses
    • Contacts <1 month of age should receive rifampin 5 mg/kg PO q12h for 4 doses.
    • Alternatively, ceftriaxone is also effective prophylaxis for contacts ≤15 years of age; a single dose of 125 mg IM is recommended.
    • For contacts >15 years old, ceftriaxone 250 mg IM is recommended. Its safety profile is preferred for pregnant women.
  • Medical personnel should receive prophylaxis only if they had close contact with respiratory secretions.
  • Vaccines for types A, C, Y, and W-135 are available and produce an immune response in 10–14 days.
  • A tetravalent conjugate meningococcal vaccine, MCV4, is licensed for use in people in the age range of 2–55 years. It is recommended in all unimmunized 11–12-year-old adolescents, with a booster dose at age 16 years.
  • Serotype B vaccine was recently approved by the FDA and is licensed for use in people 10–25 years of age.
  • The Centers for Disease Control and Prevention (CDC) continues to recommend routine adolescent immunization with the exception of persons with a history of Guillain-Barré syndrome (GBS) who are not in a high-risk group for invasive meningococcal disease. An updated fact sheet on GBS and MCV4 is available at http://www.cdc.gov/vaccinesafety/Concerns/gbsfactsheet.html. A study published in 2012 did not support an association between GBS and MCV4 vaccination.

Epidemiology

  • The rates of meningococcal disease in the United States have remained stable at 0.9–1.5 cases per 100,000 population per year.
  • Children <5 years of age are most often affected, with peak incidence between 3 and 5 months of age.
  • During epidemics, more school-aged children may be affected.
  • The disease occurs most commonly in winter and spring months.
  • Increased disease activity may follow an influenza A outbreak.

Risk Factors

  • Patients with asplenia, deficiencies of properdin C3, or a terminal complement component (C5–C9), and HIV are at increased risk for invasive and recurrent disease.
  • Organism virulence factors, such as differences in the bacterial cell wall lipopolysaccharide, play a role in disease severity. Less virulent organisms are more likely in chronic meningococcemia, which has a favorable prognosis.

Genetics

  • Inherited deficiency of terminal complement may be found in 5–10% of patients during epidemics. The frequency increases to 30% in patients with recurrent disease.
  • A number of other immune function–related genes associated with either susceptibility or protection from infection have been identified.

Pathophysiology

  • Fulminant disease is signified by diffuse microvascular damage and disseminated intravascular coagulation (DIC); see “Diagnosis” section.
  • Death results from effects of endotoxic shock, including circulatory collapse and myocardial dysfunction.

Etiology

  • Colonization and infection of the upper respiratory tract occurs after inhalation of, or direct contact with, the organism, usually in oral secretions.
  • Disseminated disease occurs when the organism penetrates the nasal mucosa and enters the bloodstream, where it replicates.

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Basics

Description

  • A systemic infection with the bacterium Neisseria meningitidis, a gram-negative diplococcus that is relatively fastidious. Despite treatment with appropriate antibiotics, this disease may have a fulminant course (i.e., significant complications within hours of presentation) with a high likelihood of mortality.
  • 13 serogroups have been described on the basis of capsular polysaccharide antigens; serotypes B, C, and Y account for most of the cases in the United States. Serogroup Y accounted for 30% of cases between 1996 and 1998.

General Prevention

  • Isolation of the hospitalized patient; hospitalized patients require respiratory isolation until 24 hours after initiation of appropriate antibiotic therapy.
  • Exposed contacts, including household, day care, and nursery school, should receive the following:
    • Rifampin, 10 mg/kg (maximum 600 mg) PO q12h for 4 doses
    • Contacts <1 month of age should receive rifampin 5 mg/kg PO q12h for 4 doses.
    • Alternatively, ceftriaxone is also effective prophylaxis for contacts ≤15 years of age; a single dose of 125 mg IM is recommended.
    • For contacts >15 years old, ceftriaxone 250 mg IM is recommended. Its safety profile is preferred for pregnant women.
  • Medical personnel should receive prophylaxis only if they had close contact with respiratory secretions.
  • Vaccines for types A, C, Y, and W-135 are available and produce an immune response in 10–14 days.
  • A tetravalent conjugate meningococcal vaccine, MCV4, is licensed for use in people in the age range of 2–55 years. It is recommended in all unimmunized 11–12-year-old adolescents, with a booster dose at age 16 years.
  • Serotype B vaccine was recently approved by the FDA and is licensed for use in people 10–25 years of age.
  • The Centers for Disease Control and Prevention (CDC) continues to recommend routine adolescent immunization with the exception of persons with a history of Guillain-Barré syndrome (GBS) who are not in a high-risk group for invasive meningococcal disease. An updated fact sheet on GBS and MCV4 is available at http://www.cdc.gov/vaccinesafety/Concerns/gbsfactsheet.html. A study published in 2012 did not support an association between GBS and MCV4 vaccination.

Epidemiology

  • The rates of meningococcal disease in the United States have remained stable at 0.9–1.5 cases per 100,000 population per year.
  • Children <5 years of age are most often affected, with peak incidence between 3 and 5 months of age.
  • During epidemics, more school-aged children may be affected.
  • The disease occurs most commonly in winter and spring months.
  • Increased disease activity may follow an influenza A outbreak.

Risk Factors

  • Patients with asplenia, deficiencies of properdin C3, or a terminal complement component (C5–C9), and HIV are at increased risk for invasive and recurrent disease.
  • Organism virulence factors, such as differences in the bacterial cell wall lipopolysaccharide, play a role in disease severity. Less virulent organisms are more likely in chronic meningococcemia, which has a favorable prognosis.

Genetics

  • Inherited deficiency of terminal complement may be found in 5–10% of patients during epidemics. The frequency increases to 30% in patients with recurrent disease.
  • A number of other immune function–related genes associated with either susceptibility or protection from infection have been identified.

Pathophysiology

  • Fulminant disease is signified by diffuse microvascular damage and disseminated intravascular coagulation (DIC); see “Diagnosis” section.
  • Death results from effects of endotoxic shock, including circulatory collapse and myocardial dysfunction.

Etiology

  • Colonization and infection of the upper respiratory tract occurs after inhalation of, or direct contact with, the organism, usually in oral secretions.
  • Disseminated disease occurs when the organism penetrates the nasal mucosa and enters the bloodstream, where it replicates.

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