Meningococcemia

Answer 1

Definition

Meningococcemia is an acute and potentially life-threatening infection of the bloodstream that commonly leads to inflammation of the blood vessels (vasculitis).

See also: Septicemia

Alternative Names

Meningococcal septicemia; Meningococcal blood poisoning; Meningococcal bacteremia

Causes, incidence, and risk factors

Meningococcemia is caused by a bacteria called Neisseria meningitidis. The bacteria frequently lives in a person's upper respiratory tract without causing visible signs of illness. The bacteria can be spread from person to person through respiratory droplets -- for example, you may become infected if you are around someone with the condition when they sneeze or cough.

Family members and those closely exposed to someone with the condition are at increased risk. The infection occurs more frequently in winter and early spring.

Symptoms

There may be few symptoms at first. Some may include:

• Anxiety
• Fever
• Irritability
• Spotty red or purple rash (petechiae)

Additional symptoms may include:

• Headache
• Muscle and joint pain
• Nausea
• Vomiting

Later symptoms may include:

• Changing level of consciousness
• Ill appearance
• Large areas of bleeding under the skin (purpura)
• Shock

Signs and tests

Blood tests will be done to rule out other infections and help confirm meningococcemia. Such tests may include:

• Blood culture
• Complete blood count with differential
• Clotting studies (PT, PTT)

Other tests that may be done include:

• Lumbar punctureto obtain spinal fluid sample for CSF culture
• Skin biopsy and gram stain
• Urinalysis

Treatment

Persons with this type of infection are often admitted to the intensive care unit of the hospital, where they are closely monitored. The person may be placed in respiratory isolation for the first 24 hours to help prevent the spread of the infection to others.

Treatments may include:

• Antibiotics given through a vein (IV)
• Breathing support
• Clotting factors or platelet replacement -- if bleeding disordersdevelop
• Fluids through a vein (IV)
• Medications to treat blood pressure problems
• Wound care for areas of skin with blood clots

Expectations (prognosis)

Early treatment results in a good outcome. When shock develops, the outcome is less certain.

The condition is most life threatening in those who have:

• Disseminated intravascular coagulopathy (DIC) - a severe bleeding disorder
• Kidney failure
• Profound shock

Patients who do not develop meningitis also tend to have a poorer outcome.

Complications

• Arthritis
• Blood clotting that leads to the loss of the arms or legs
• Disseminated intravascular coagulopathy (DIC)
• Inflammation of blood vessels in the skin (cutaneous vasculitis)
• Irreversible shock
• Pericarditis
• Profound shock
• Severe damage to adrenal glands that can lead to low blood pressure (Waterhouse-Friderichsen syndrome)

Calling your health care provider

Go to the emergency room immediately if you have symptoms of meningococcemia. Call your doctor if you have been around someone with the disease.

Prevention

Preventive antibiotics for family members and contacts are often recommended. Speak with your 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 who live in dormitories. You should discuss the appropriate use of this vaccine with your health care provider.

References

Apicella MA. Meningococcal infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 321.

Apicella MA. Neisseria meningitides. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005: chap 208.

Fernandez-Frackelton M. Bacteria. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006: chap 127.

Answer 2

Definition

Meningococcemia is an acute and potentially life-threatening infection of the bloodstream.

See also: Septicemia

Alternative Names

Meningococcal septicemia; Meningococcal blood poisoning; Meningococcal bacteremia

Causes, incidence, and risk factors

Meningococcemia is caused by a bacteria called Neisseria meningitidis. The bacteria frequently lives in a person's upper respiratory tract without causing visible signs of illness. The bacteria can be spread from person to person through respiratory droplets -- for example, you may become infected if you are around someone with the condition when they sneeze or cough.

Family members and those closely exposed to someone with the condition are at increased risk. The infection occurs more frequently in winter and early spring.

Symptoms

There may be few symptoms at first. Some may include:

• Anxiety
• Fever
• Headache
• Irritability
• Muscle pain
• Nausea
• Rash with red or purple spots (petechiae)

Later symptoms may include:

• Changing level of consciousness
• Large areas of bleeding under the skin (purpura)
• Shock

Signs and tests

Blood tests will be done to rule out other infections and help confirm meningococcemia. Such tests may include:

• Blood culture
• Complete blood count with differential
• Clotting studies (PT, PTT)

Other tests that may be done include:

• Lumbar punctureto obtain spinal fluid sample for CSF culture
• Skin biopsy and gram stain
• Urinalysis

Treatment

Meningococcemia is a medical emergency. Persons with this type of infection are often admitted to the intensive care unit of the hospital, where they are closely monitored. The person may be placed in respiratory isolation for the first 24 hours to help prevent the spread of the infection to others.

Treatments may include:

• Antibiotics given through a vein (IV), given immediately
• Breathing support
• Clotting factors or platelet replacement -- if bleeding disordersdevelop
• Fluids through a vein (IV)
• Medications to treat low blood pressure
• Wound care for areas of skin with blood clots

Expectations (prognosis)

Early treatment results in a good outcome. When shock develops, the outcome is less certain.

The condition is most life threatening in those who have:

• Disseminated intravascular coagulopathy (DIC) - a severe bleeding disorder
• Kidney failure
• Shock

Patients who do not develop meningitis also tend to have a poorer outcome.

Complications

• Arthritis
• Disseminated intravascular coagulopathy (DIC)
• Gangrene due to lack of blood supply
• Inflammation of blood vessels in the skin (cutaneous vasculitis)
• Myocarditis
• Pericarditis
• Shock
• Severe damage to adrenal glands that can lead to low blood pressure (Waterhouse-Friderichsen syndrome)

Calling your health care provider

Go to the emergency room immediately if you have symptoms of meningococcemia. Call your doctor if you have been around someone with the disease.

Prevention

Preventive antibiotics for family members and contacts are often recommended. Speak with your health care provider about this option.

A vaccine that covers some -- but not all -- strains of meningococcus is recommended for children. Unvaccinated college students who live in dormitories should also consider receiving this vaccine. In this scenario, it should be given a few weeks before they first move into the dormitory. You should discuss the appropriate use of this vaccine with your health care provider.

References

Apicella MA. Meningococcal infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 321.

Reviewed By

Review Date: 09/15/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.