Meningococcemia

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

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

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

Later symptoms and signsmay include:

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

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

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
• Breathingsupport
• 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

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

• 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

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

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.