Meningococcal Meningitis And Septicaemia

The fatality rate for meningococcal disease in childhood is highest (10%) in neonates.

It is recommended that children and young people should be reviewed with the results of their hearing test at least 4-6weeks after discharge from hospital.

Bacterial meningitis in children and young people is associated with case fatality rates of 2-11%, the rate being particularly high (10%) in neonates

The NICE (UK) guideline was published in June 2010.

Special investigations for meningoccal disease are whole blood real time Polymerase chain reaction and LP to confirm a diagnosis of meningococcal disease.

The highest incidence of meningococcal disease occurs in children under 2 years, with further peaks in incidence occurring in adolescence and early adulthood.

Signs of shock include Capillary refill time longer than 2 seconds, Unusual skin colour, Tachycardia or hypotension, Respiratory symptoms or breathing difficulty, Leg pain, Altered mental state or decreased consciousness, Poor urine output

In older children and young people, bacterial meningitis is usually caused by N meningitidis (meningococcus), S pneumoniae (pneumococcus), or Haemophilus influenzae type b, which colonise the upper respiratory tract and can cause invasive disease in susceptible people.

Give intravenous ceftriaxone immediately to children and young people with a petechial rash if any of the following occur at any point during the assessment (these children are at high risk of having meningococcal disease):
− petechiae start to spread
− the rash becomes purpuric
− there are signs of bacterial meningitis
− there are signs of meningococcal septicaemia
− the child or young person appears ill to a healthcare professional

You can give fluid boluses by the Intravenous or Intraosseous routes for management of shock

Signs of septicaemia include Impaired consciousness, Toxic or moribund state, Shock, Hypotension, Leg pain, Cold hands or feet

Signs of meningitis are Photophobia, Kernig’s sign or Brudzinski’s sign, Paresis or Seizures, Bulging fontanelle, Diarrhoea, abdominal pain, or distension, Focal neurological deficit.

Possible complications of meningococcal septicaemia and meningitis include hearing loss, damage to bones and joints, skin scarring from necrosis, psychosocial problems
neurological disorders, delayed or impaired development and renal failure.
Rarer complications include Waterhouse-Friderichsen syndrome and DIC

Neisseria Meningitidis is an heterotrophic gram-negative diplococcal first discovered by Anton Weichselbaum in 1887
It exists as normal flora in the nasopharynx of up to 5-15% of adults.

Clinical presentation of meningococcal disease include mostly non-specific symptoms or signs, difficult to distinguish from other less important (viral) infections in children or shock, more specific symptoms and signs are more likely to be secondary to bacterial meningitis or meningococcal septicaemia.

In neonates, bacterial meningitis is often caused by organisms acquired from the maternal genital tract and gastrointestinal tract around the time of birth. Such organisms include S agalactiae (group B streptococcus), E coli, Strep pneumoniae, and Listeria monocytogenes.

The indications for corticosteroids in meningococcal meningitis include a dose of 0.15 mg/kg to a maximum dose of 10 mg, four times daily for four days. Other indications include the presence of frankly purulent cerebrospinal fluid, CSF white blood cell count greater than 1000/μl with a protein concentration greater than 1 g/l, and the presence of bacteria in the CSF on Gram stain. These criteria help determine when corticosteroids should be used as a treatment for meningococcal meningitis.

Contraindications to a lumbar puncture include signs suggesting raised intracranial pressure, shock, extensive or spreading purpura, after convulsions until stabilised, coagulation abnormalities, local superficial infection at the lumbar puncture site, respiratory insufficiency

Do not restrict fluids unless there is evidence of − raised intracranial pressure, or increased antidiuretic hormone secretion.
If the signs of shock persist after the first 20ml/kg bolus, immediately give a second bolus of 20 ml/kg of intravenous or intraosseous normal saline or human albumin 4.5% solution over 5–10 minutes

If the signs of shock still persist after the first 40 ml/kg:
◊ immediately give a third bolus of 20 ml/kg of intravenous or intraosseous sodium chloride 0.9% or human albumin 4.5% solution
◊ call for anaesthetic assistance for urgent tracheal intubation and mechanical ventilation and
◊ start treatment with vasoactive drugs

The given answer provides a comprehensive explanation about the antimicrobial agents that are effective against meningococci. It states that ceftriaxone, cefotaxime, and cefuroxime are cephalosporins that can penetrate into the cerebrospinal fluid (CSF) from the blood, making them suitable for the treatment of bacterial meningitis. It also mentions that meningococci are susceptible to chloramphenicol, rifampin, erythromycin, tetracyclines, and ciprofloxacin. Additionally, it provides specific treatment recommendations for children based on their age.

The correct answer includes all the recommended measures for chemoprophylaxis in meningococcal disease. These measures include providing chemoprophylaxis to all recent significant contacts of the infected patient, using rifampicin, ceftriaxone, or ciprofloxacin, minocycline, and spiramycin as possible options for chemoprophylaxis, avoiding chemoprophylaxis during epidemics due to multiple sources of exposure and prolonged risk, and administering either a single IM injection of ceftriaxone or 4 oral doses of rifampin over 2 days to children based on their body weight. Ciprofloxacin is not recommended for individuals older than 18 years.

The correct answer includes individuals who had direct exposure to the patient through close contact activities such as kissing, sharing utensils, or medical interventions like mouth-to-mouth resuscitation. It also includes individuals who had significant exposure by sitting beside the patient on a long airplane flight of more than 8 hours. Additionally, prophylaxis should be given to contact young children and their carers or nursery-school contacts. This means that anyone who frequently ate, slept, or stayed at the patient's home during the 14 days before the onset of symptoms should also receive prophylaxis. Co-workers and school classmates are not mentioned as constituting significant exposure for meningococcal chemoprophylaxis.