RISK FACTORS: Age 3 months to 1 year, Late complement component deficiency (C5, C6, C7, C8 or C9), Household contacts, Contacts in nurseries and day care centers, Close quarters (e.g., dormitories, campus bars, and military barracks)
APPROPRIATE HEALTH CARE
β’ If meningitis suspected, immediate lumbar puncture
β’ If lumbar puncture is delayed, administer antibiotic immediately
β’ Admit patient to ICU, if severe sepsis or meningitis suspected
β’ Droplet isolation, for 24 hours from the beginning of antibiotic therapy, is appropriate
GENERAL MEASURES
β’ Appropriate antibiotic
β’ Supportive care including IV fl uids, oxygen when needed
β’ Close monitoring of patient for seizure activity
β’ Treat complications (e.g., DIC, ARDS, renal failure, adrenal failure
ACTIVITY As tolerated depending on clinical condition
DIET As tolerated depending on clinical condition
PATIENT EDUCATION
β’ Educate family and close contacts regarding risk of contracting meningococcal infections
β’ Educate healthcare personnel who are not at risk of contracting meningococcal infections
DRUG(S) OF CHOICE
β’ In patients with severe mental changes, consider administering dexamethasone 0.15 mg/kg q 6h x 16 doses, starting 15 minutes before first dose of antibiotic
β’ When treating a patient with suspected meningitis, initiate early therapy with broad spectrum coverage such
as a third generation cephalosporin plus vancomycin. Once N. meningitidis is identifi ed, the drug of choice
remains penicillin
β’ For meningitis - penicillin G 4 million units IV q 4h (children 0.25 mU/kg IV q 4-6h) or ampicillin 2 g IV q 4h
(children 200-300 mg/kg IV q 6h)
β’ For other infections - use half the dose for meningitis
β’ Duration of treatment 7-10 days
β’ Chemoprophylaxis for close contacts (household members, personnel in nurseries, day care centers, nursing
homes, dormitories and other closed institutions).
Regimen: rifampin 600 mg (children 10 mg/kg) po q12h for 2 days or for adults only, one dose of ciprofloxacin
750 mg po. (No chemoprophylaxis is needed for casual contacts, health care personnel (except persons giving mouth-to-mouth resuscitation), schoolmates, office co-workers).
ALTERNATIVE DRUGS
. For meningitis - chloramphenicol 1 g IV q 6h (in children 75-100 mg/kg q 6h) or ceftriaxone 2 g IV q 12h
(children 80-100 mg/kg q 12-24h)
. Ceftriaxone should not be used in patients with history of anaphylactic reactions to penicillin (hypotension,
laryngeal edema, wheezing, hives, etc.)
. Chloramphenicol may cause aplastic anemia
. For other infections - ceftriaxone 1 g (children 40 mg/kg) IV q 24h
PATIENT MONITORING In patients with neurologic deficits, follow-up with neurologist may be needed
PREVENTION/AVOIDANCE Before discharge, give patient rifampin 600 mg (children 10 mg/kg) po q 12h for 2 days to eradicate carriage or for adults only, one dose of ciprofl oxacin 500-750 mg po
POSSIBLE COMPLICATIONS
β’ Disseminated intravascular coagulation
β’ Acute tubular necrosis
β’ Seizures
β’ Focal neurologic deficit
β’ Cranial nerve palsies
β’ Sensorineural hearing loss
β’ Obstructive hydrocephalus
β’ Subdural effusions
β’ Acute adrenal hemorrhage (Waterhouse-Friderichsen syndrome)
EXPECTED COURSE/PROGNOSIS
Overall mortality 10%
OTHER NOTES
β’ Vaccine containing polysaccharides of groups A, C, Y and W-135 is available for persons with late complement deficiency, anatomic or functional asplenia. Vaccination is also recommended for travelers to the
Haj in Saudi Arabia and other areas with epidemic meningococcal disease (e.g., West Africa). It should also
be considered for use in freshmen college students living in dormitories.