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Meningococcemia

Definition

Meningococcemia is an acute (sudden onset) infection of the bloodstream and developing vasculitis (inflammation of the blood vessels) caused by the bacteria Neisseria meningitidis.

Alternative Names

Causes

Neisseria meningitidis frequently lives in the upper respiratory tract without causing visible signs of illness. Some event is thought to trigger the onset of aggressive behavior of the bacteria, and sporadic cases of meningococcemia and meningococcal meningitis appear.

Family members and those closely exposed to an infected individual are at increased risk. The infection occurs more frequently in winter and early spring. It is transmitted from person to person by respiratory droplets.

Symptoms

Symptoms may be very few at first, and can include:

• Fever
• Petechial (spotty red or purple) rash
• Irritability
• Anxiety

Later symptoms and signs may include:

• Ill appearance
• Changing level of consciousness
• Shock
• Large areas of bleeding or blood clots under the skin

Exams and Tests

• CBC with differential
• Blood culture
• Gram stain of positive culture
• Skin biopsy and gram stain
• Urinalysis
• Clotting studies (PT, PTT)

Treatment

Patients are often admitted to the intensive care unit of the hospital. Intensive monitoring and treatment are needed.

Supportive measures for shock include:

• IV fluids
• Breathing support
• Medical support of blood pressure

Medications include intravenous (IV) antibiotics to eliminate the infection. Clotting factors or platelet replacement may be needed if bleeding disorders develop.

Other treatments:

• Wound care for areas of skin with blood clots
• Respiratory isolation for first 24 hours, to avoid spread to other patients

Outlook (Prognosis)

Early treatment results in a good outcome. When shock develops, the outcome is more guarded. Profound shock, DIC (a severe bleeding disorder), and kidney failure all make the outcome poor, with possibility of a death. Patients without meningitis tend to have a poorer prognosis.

Possible Complications

• Profound shock
• Limb loss secondary to clots (thrombosis)
• Irreversible shock
• Disseminated intravascular coagulopathy (DIC)
• Waterhouse-Friderichsen syndrome
• Arthritis
• Cutaneous vasculitis (inflammation of blood vessels in the skin)
• Pericarditis

When to Contact a Medical Professional

Go to the emergency room immediately if your child has symptoms suggestive of meningococcemia.

Prevention

Prophylaxis (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.

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