Meningococcal Infection

Question 1

A 4 year old girl who recently started school is brought to her GP with a 24 hour history of feeling generally unwell, tiredness and headache. She has been eating and drinking but less than normal. Her mother states that she is usually happy and healthy but seems to have got gradually worse today. No one else in her class has been unwell. She has no past medical history and does not take any regular medications.

On examination the child looks unwell and appears quite withdrawn. Vital signs: pulse 100bpm, BP 110/70, respiratory rate 22/min, oxygen saturations 98%, temperature 38.5 degrees C. Systems examination is unremarkable. She has cold hands and feet and a non-blanching purpuric rash on her left upper thigh.

What should the GP’s initial management be?

Answer 1

Intramuscular benzylpenicillin

Early treatment should be given even when meningococcal infection is suspected, with intramuscular or intravenous benzylpenicillin not oral

Question 2

Meningococcal infection is caused by Neisseria meningitidis, a gram-… intracellular diplococcus. This is carried in the nasopharynx by many children and young adults and some strains can become invasive and cause fatal septicaemia if untreated.

Answer 2

Meningococcal infection is caused by Neisseria meningitidis, a gram-negative intracellular diplococcus. This is carried in the nasopharynx by many children and young adults and some strains can become invasive and cause fatal septicaemia if untreated.

Question 3

Infection with Neisseria meningitidis can present either as:

Answer 3

Meningococcaemia (septicaemia)
Meningitis (non-specific signs such as lethargy, headache, fever, rigors and vomiting).
A mixture of both, associated with a rapidly developing purpuric skin rash.
Hypovolaemic shock may present with cold peripheries, poor capillary refill time and tachycardia, with decreased urine output.
When this is associated with massive adrenal haemorrhage and septic shock, the presentation is known as Waterhouse-Friderichsen syndrome. This is rare.

Question 4

Diagnosis of meningococcal infection

Answer 4

Diagnosis of meningococcal infection is confirmed by blood or CSF cultures (as appropriate).
Polymerase chain reaction (PCR) testing for Neisseria meningitidis is highly sensitive.

Question 5

Management of meningococcal infectio

Answer 5

Early antibiotic treatment should be given when meningococcal infection is suspected. This will usually be broad-spectrum IV antibiotics until confirmation of the pathogen, after which antibiotics may be narrowed to penicillin-based drug if sensitivities permit.
Patients are likely to need PICU admission if septicaemic.
Infections caused by Neisseria meningitidis are notifiable diseases

Question 6

Prevention of meningococcal infection

Answer 6

All household or close contacts should receive ciprofloxacin or rifampicin as post-exposure prophylaxis.
Multiple strains of Neisseria meningitidis covered as part of the routine immunisation schedule