What is the most common cause of death from Neisseria (N.) meningitidis infection?

From the Guidelines

The most common cause of death from meningococcal disease is septic shock, which can rapidly progress to multiple organ failure if not promptly treated with antibiotics and supportive care. When Neisseria meningitidis bacteria enter the bloodstream, they can trigger a severe inflammatory response called meningococcemia, which can rapidly progress to septic shock 1. This condition involves a dramatic drop in blood pressure, impaired organ perfusion, and ultimately multiple organ failure. The bacteria release endotoxins that damage blood vessels, causing them to leak fluid into surrounding tissues. This leads to decreased blood volume, poor tissue perfusion, and formation of blood clots in small vessels. As the condition worsens, vital organs like the kidneys, liver, lungs, and heart begin to fail. Some key points to consider in the management of meningococcal disease include:

• The epidemiology of meningococcal meningitis varies per region of the world, with serogroup B being the most common in European countries, and serogroup A being the major cause of epidemics in sub-Saharan Africa 1.
• The introduction of conjugated vaccines has led to a significant reduction in serogroup C disease in countries such as The Netherlands and the UK 1.
• A vaccine of four meningococcal serogroup B antigens has been developed, which has been shown to be immunogenic and reduce nasopharyngeal carriage in a randomized controlled trial 1.
• Reduced susceptibility to penicillin of meningococci has been described in multiple countries, although the majority of patients infected with meningococci with intermediate susceptibility to penicillin respond well to penicillin 1. The rapid progression of meningococcal septic shock is particularly dangerous, with death potentially occurring within hours of symptom onset. Early recognition and prompt treatment with antibiotics (typically ceftriaxone or penicillin G) and aggressive supportive care are essential to prevent this fatal outcome.

From the Research

Meningococcal Disease

• Meningococcal disease is a major cause of bacterial meningitis and septicaemia worldwide, with high case fatality rates and serious life-long complications among survivors 2.
• The disease is caused by Neisseria meningitidis, with twelve serogroups recognised, of which six (A, B, C, W, X and Y) are responsible for nearly all cases of invasive meningococcal disease (IMD) 2.

Common Cause of Death

• The most common cause of death from meningococcal disease is not explicitly stated in the provided studies, but it is mentioned that serogroup B is the main cause of MD in Europe and North America and one of the most prevalent serogroups in Latin America 3.
• Serogroup B meningococcal disease has a high case fatality rate and is a significant cause of meningitis and sepsis worldwide 3, 4.

Serogroups Responsible for IMD

• The incidence of IMD and responsible serogroups vary widely both geographically and over time 2.
• Other serogroups, such as W, have become more important causes of IMD due to the emergence of hypervirulent clones 2.
• The introduction of meningococcal C conjugate vaccines has led to rapid declines in meningococcal C disease, whilst implementation of a meningococcal A conjugate vaccine has led to near-elimination of meningococcal A disease 2.