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Meningococcal Treatment

Meningococcal disease is potentially fatal and should always be viewed as a medical emergency. Admission to a hospital or health center is necessary. Antibiotic treatment must be started early in the course of the disease (in patients with meningitis, lumbar puncture should be done before starting antibiotics if possible to ensure the bacteria will grow in culture). On presentation the appropriate antibiotics for treatment are dictated by the differential diagnosis; once the diagnosis is confirmed, several antibiotic choices are available, and an infectious disease consultant can be asked to assist in management.

Occurrence

Sporadic cases and outbreaks of meningococcal disease occur throughout the world. In the sub-Saharan African “meningitis belt,” which extends from Mali to Ethiopia, peaks of serogroup A meningococcal disease occur regularly during the dry season (December through June). In addition, major epidemics occur every 8-12 years. In 2000, a serogroup W-135 epidemic occurred in Saudi Arabia in association with the Hajj pilgrimage. Cases among returning pilgrims and their families occurred in a number of countries, including several cases in the United States. In 2002, a major meningococcal disease epidemic occurred in Burkina Faso caused by serogroup W-135. Since 2002, serogroup W-135 has been detected in several African countries, but it has not caused major epidemics.

Risk for Travelers

Travelers to sub-Saharan Africa may be at risk for meningococcal disease. Travelers to the meningitis belt during the dry season should be advised to receive meningococcal vaccine, especially if they will have prolonged contact with local populations. Prompted by a serogroup A meningococcal disease outbreak associated with the 1987 Hajj, Saudi Arabia requires that Hajj and Umrah visitors have a certificate of vaccination with a tetravalent (A,C,Y,W-135) meningococcal vaccine before entering.

Clinical Presentation

Sudden onset of fever, intense headache, neck stiffness, nausea, and often vomiting are common signs and symptoms of meningococcal sepsis, with or without meningitis, in persons over the age of 2 years. These symptoms can develop over several hours, or they may take 1-2 days. Other symptoms may include photophobia and an altered mental status. In infants, a slower onset of signs and symptoms may occur with nonspecific symptoms, and neck stiffness may be absent.

Early diagnosis and treatment are critical. If symptoms occur, the patient should seek medical care immediately. The diagnosis is usually made by growing bacteria collected from cerebrospinal fluid (CSF), detection of the meningococcal antigen through latex agglutination in fresh CSF, or evidence of N. meningitidis DNA by polymerase chain reaction. N. meningitidis can also be identified in blood cultures.

The signs and symptoms of meningococcal meningitis are similar to those of other causes of bacterial meningitis, such as Haemophilus influenzae and Streptococcus pneumoniae. Identification of the type of bacteria responsible is important for selection of correct antibiotics. Answers to frequently asked questions about meningitis can be found at the following website: http://www.cdc.gov/ncidod/dbmd/diseaseinfo.