From the Guidelines
For meningococcemia with shock, in addition to IV fluids and antibiotics, corticosteroids should be given within the first 24 hours, specifically in cases of refractory septic shock with documented adrenal hypo-responsiveness, as well as vasopressors for managing shock. The management of meningococcemia with shock involves a multifaceted approach to address the infection, the inflammatory response, and the hemodynamic instability.
- The use of corticosteroids, such as low-dose steroid supplementation, may improve survival in patients with refractory septic shock and documented adrenal hypo-responsiveness 1.
- Vasopressors, with norepinephrine as the first-line agent, are essential for managing shock, starting at 0.05-0.1 mcg/kg/min, titrated to maintain mean arterial pressure ≥65 mmHg 1.
- Patients may require mechanical ventilation for respiratory support and close monitoring in an intensive care setting with frequent assessment of vital signs, mental status, urine output, and laboratory parameters.
- The aim of fluid replacement in meningococcal sepsis is to reverse shock, as shown by normalization of lactate levels and maintenance of urine output at ≥0.5 ml/kg/h, with the type of fluid to be given being crystalloids as the initial fluid of choice 1.
- The administration of effective IV antimicrobials within the first hour of recognition of septic shock is crucial, with empiric broad-spectrum therapy to cover all likely pathogens, including bacterial and potentially fungal or viral coverage 1.
From the Research
Treatment for Meningococemia with Shock
In addition to IV fluid and antibiotics, the following treatments may be considered within the first 24 hours:
- Hydrocortisone: as seen in the case report 2, the use of hydrocortisone in combination with antibiotics and volume resuscitation resulted in stabilization of hemodynamics and control of hyperinflammation.
- Supportive care: including management of the systemic circulation, respiration, and intracranial pressure, as highlighted in 3 and 4.
- Aggressive fluid resuscitation: as mentioned in 4, fluid resuscitation is an important part of supportive care, but the optimal volume of fluid is still a topic of debate, with some studies suggesting that maintaining intravenous fluids rather than restricting them in the first 48 hours may be beneficial in settings with high mortality rates 5.
- Vasopressor support: as seen in the case report 2, the use of vasopressors may be necessary to support blood pressure, and the dosage may be decreased as the patient's condition improves.
Pathogenesis and Response
The inflammatory and hemostatic response in meningococcal sepsis is complex and involves a proinflammatory state, endothelial dysfunction, and activation of the hemostatic response, which may lead to disseminated intravascular coagulation 6.