Meningococcemia is also known as meningococcal septicemia, meningococcal blood poisoning or meingococcal bacteremia.
Meningococcemia is an acute (sudden onset) infection of the bloodstream and subsequent vasculitis (inflammation of the blood vessels) caused by the bacteria Neisseria meningitidis.
Neisseria meningitidis frequently lives in the upper respiratory tract with no evidence of illness. Some event is thought to trigger the onset of aggressive behavior of the organism and sporadic cases of meningococcemia and meningococcal meningitis appear.
Family members and those closely exposed to an infected individual are at increased risk. The infection occurs more frequently in winter and early spring. It is transmitted from person-to-person by respiratory droplets.
Symptoms may be very few at first, and can include:
Fever
Petechial (spotty red or purple) rash
Irritability
Appears anxious
Later symptoms and signs can include:
Appears acutely ill
Changing level of consciousness
Shock
Large areas of hemorrhage and/or thrombosis under the skin
Signs and tests
CBC with differential
Blood culture
Gram stain of positive culture
Skin biopsy and Gram stain
Urinalysis
Clotting studies (PT, PTT)
Treatment
Patients are often admitted to the intensive care unit of the hospital. Intensive monitoring and treatment are needed.
Supportive measures for shock include:
IV fluids
Ventilatory support
Medical support of blood pressure
Medications include intravenous (IV) antibiotics to eliminate the infection, and high doses of corticosteroids for shock (must be given early). Clotting factors or platelet replacement may be needed if bleeding disorders develop.
Other treatments:
Wound care for thrombosed (with blood clots) areas of skin
Respiratory isolation for first 24 hours, to avoid spread to other patients
Expectations (prognosis):
Early treatment results in a good outcome. When shock develops, the outcome is more guarded. Profound shock, DIC (a severe bleeding disorder), and adrenal collapse all predispose the patient to a poor prognosis with possibility of a death. Patients without meningitis tend to have a poorer prognosis.
Complications:
Profound shock
Limb loss secondary to clots (thrombosis)
Irreversible shock
Disseminated intravascular coagulopathy (DIC)
Waterhouse-Friderichsen syndrome
Arthritis
Cutaneous vasculitis (inflammation of blood vessels in the skin)
Pericarditis
Call your health care provider immediately or go to the emergency room if your child has symptoms suggestive of meningococcemia.
Prophylaxis (preventive antibiotics) for family members and contacts are often recommended. Speak with you health care provider about this option.
A vaccine that covers some but not all strains of meningococcus is available and has been suggested for use by college students. You should discuss the appopriate use of this vaccine with your health care provider. From http://www.nlm.nih.gov/medlineplus/ency/article/001349.htm
Meningococcal disease is a communicable infection caused by Neisseria meningitidis. It is transmitted from person to person via respiratory secretions. N meningitidis infection can be clinically polymorphic. The most common disease presentation is meningitis. Rarely, N meningitidis infection may manifest as chronic meningococcemia that resembles the arthritis-dermatitis syndrome of gonococcemia; however, acute meningococcal septicemia (also called meningococcemia) is the most devastating form of the disease.
Meningococcemia can kill more rapidly than any other infectious disease. Early recognition is critical to implement prompt antibiotic therapy and supportive care. Treatment must be instituted rapidly because irreversible shock and death may occur within hours of the onset of symptoms. Cutaneous manifestations in meningococcemia may be important clues to the diagnosis. Skin involvement can be the most dramatic aspect of the disease and is often the first sign that leads to the clinical consideration of meningococcemia.
More information at Meningococcemia
Prevention and Control of Meningococcal Disease. Recommendations of the Advisory Committee on Immunizaiton Practices (ACIP)
In January 2005, a tetravalent meningococcal polysaccharide-protein conjugate vaccine ([MCV4] Menactra,™ manufactured by Sanofi Pasteur, Inc., Swiftwater, Pennsylvania) was licensed for use among persons aged 11–55 years. CDC’s Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of young adolescents (defined in this report as persons aged 11–12 years) with MCV4 at the preadolescent health-care visit (at age 11–12 years). Introducing a recommendation for MCV4 vaccination among young adolescents might strengthen the role of the preadolescent visit and have a positive effect on vaccine coverage among adolescents. For those persons who have not previously received MCV4, ACIP recommends vaccination before high-school entry (at approximately age 15 years) as an effective strategy to reduce meningococcal disease incidence among adolescents and young adults. By 2008, the goal will be routine vaccination with MCV4 of all adolescents beginning at age 11 years. Routine vaccination with meningococcal vaccine also is recommended for college freshmen living in dormitories and for other populations at increased risk (i.e., military recruits, travelers to areas in which meningococcal disease is hyperendemic or epidemic, microbiologists who are routinely exposed to isolates of Neisseria meningitidis, patients with anatomic or functional asplenia, and patients with terminal complement deficiency). Other adolescents, college students, and persons infected with human immunodeficiency virus who wish to decrease their risk for meningococcal disease may elect to receive vaccine.
This report updates previous reports from ACIP concerning prevention and control of meningococcal disease. It also provides updated recommendations regarding use of the tetravalent meningococcal polysaccharide vaccine (MPSV4) and on antimicrobial chemoprophylaxis.
Prevention and Control of Meningococcal Disease. Recommendations of the Advisory Committee on Immunizaiton Practices (ACIP) is found in the MMWR Recommendations and Reports May 27, 2005 Pages 1-21.
