What is the diagnosis and treatment for Neisseria (N.) meningitidis infection, also known as Meningococcemia?

From the Guidelines

Meningococcemia requires immediate medical attention with prompt administration of antibiotics, typically starting with ceftriaxone 2g IV every 12 hours or penicillin G 4 million units IV every 4 hours for 7-14 days, as recommended by the most recent guidelines 1. The treatment of meningococcemia involves hospitalization, often in intensive care, as the condition can rapidly progress to shock, organ failure, and death. Supportive care including fluid resuscitation, vasopressors for hypotension, and respiratory support may be necessary.

• The infection spreads through respiratory droplets and close contact, with symptoms including sudden fever, severe headache, stiff neck, vomiting, and a characteristic petechial or purpuric rash.
• Close contacts of the patient should receive prophylactic antibiotics such as ciprofloxacin 500mg as a single oral dose, rifampin 600mg orally twice daily for 2 days, or ceftriaxone 250mg IM as a single dose to prevent secondary cases, as suggested by 1.
• Vaccination against meningococcal disease is recommended for adolescents, college students living in dormitories, military recruits, and travelers to endemic areas as a preventive measure. The choice of antibiotic may depend on the local epidemiology of antibiotic resistance, with third-generation cephalosporins such as ceftriaxone being a suitable option in cases where penicillin resistance is suspected, as noted in 1.
• The duration of treatment is typically 7 days, but may be adjusted based on the patient's response to treatment and the results of susceptibility testing, as recommended by 1.
• It is essential to note that delays in diagnosis and treatment can have disastrous consequences, highlighting the importance of prompt recognition and treatment, as emphasized in 1.

From the FDA Drug Label

Meningococcal meningitis and / or septicemia Neisseria meningitidis

• Meningococcemia is a serious infection caused by Neisseria meningitidis.
• The drug label for penicillin G (IV) 2 indicates that it is used to treat meningococcal meningitis and/or septicemia caused by Neisseria meningitidis.
• The drug label for cefotaxime (IV) 3 also indicates that it is active against Neisseria meningitidis, including beta-lactamase-positive and negative strains.
• Both penicillin G (IV) and cefotaxime (IV) can be used to treat meningococcemia.

From the Research

Definition and Causes of Meningococcemia

• Meningococcemia is a contagious bacterial infection caused by Neisseria meningitidis (N. meningitidis) 4.
• The virulence of Neisseria meningitidis is 100 times that of other gram-negative organisms, making prompt recognition and treatment essential to prevent significant morbidity and mortality 5.
• N. meningitidis has 13 clinically significant serogroups that are distinguishable by the structure of their capsular polysaccharides 6.

Symptoms and Diagnosis

• Clinical manifestations range from occult bacteremia to overwhelming septicemia or meningitis 7.
• Skin manifestations often develop and may be the first sign that leads to clinical suspicion of meningococcemia 7.
• The gold standard for the identification of meningococcal infection is the bacteriologic isolation of N. meningitidis from body fluids such as blood, cerebrospinal fluid (CSF), synovial fluid, and pleural fluid 6.
• Blood, CSF, and skin biopsy cultures are used for diagnosis 6.

Treatment and Management

• Management of meningococcal infection is a medical emergency that requires antibiotic therapy and intensive supportive care 6.
• Treatment consists of antibiotic therapy and supportive care, which may include aggressive fluid resuscitation, oxygen, ventilatory support, and inotropic support 7.
• The use of chemoprophylaxis and in certain circumstances vaccination are important in preventing secondary cases of meningococcal disease 7.
• Ciprofloxacin, rifampin, minocycline, and penicillin proved effective at eradicating N. meningitidis one week after treatment when compared with placebo 4.
• Rifampin was effective compared to placebo up to four weeks after treatment but resistant isolates were seen following prophylactic treatment 4.

Prevention and Prophylaxis

• Household contacts have the highest risk of contracting the disease during the first week of a case being detected 4.
• Prophylaxis is considered for close contacts of people with a meningococcal infection and populations with known high carriage rates 4.
• The use of ciprofloxacin, ceftriaxone, or penicillin should be considered for prophylaxis 4.