Name of disease:
This disease is also called meningococcal meningitis or cerebrospinal fever. The best known as a cause of meningitis, wide spread blood infection (septicemia) is more damaging and dangerous.
Definition:
Meningococcemia is the presence of meningococcus in the bloodstream. Meningococcus, a bacterium formally called Neisseria meningitidis, can be one of the most dramatic and rapidly fatal of all infectious diseases. This infection may be asymptomatic, may be retsricted to the nasopharynx or exhibit upper respiratory tract infection. It may cause meningococcal septicemia or meningitis.
2 types of infection:
Meningococcal septicemia, like many gram-negative blood infections, can cause disseminated intravascular coagulation (DIC), a condition where blood starts to clot throughout the body, sometimes causing ischemic tissue damage. DIC also causes bleeding, when the clotting factors are used up, causing the characteristic purpuric rash.
· Meningitis
Meningococcal meningitis is a consequence of bacteria entering the cerebrospinal fluid (CSF) and irritating the meninges - the membranes that line the brain and spinal cord.
Mode of Transmission:
Transmission is by direct contact with respiratory droplets from nose and throat of infected person. Carriers may exist without cases of meningitis. Transmission via inanimate objects (personal belongings) contaminated with saliva is significant. This disease is not airborne.
Incubation period:
Incubation period lasts for 2-10 days with an average of 3-4 days.
Signs and symptoms:
This disease is characterized by sudden onset of high grade fever (>38?C) lasting for 24 hours, weakness, joint and muscle pain. Petechial and / or purpuric rashes appearing within 24 hours after onset of fever, and signs of meningeal irritation such as headache, nausea and vomiting, stiff neck, bulging fontanels (among infants), seizure or convulsion and sensorial changes.
Diagnosis and laboratory tests:
Diagnosis is confirmed by demonstration of the bacteria in a gram-stained smear of the cerebrospinal fluid (CSF) and the isolation of the bacteria from the CSF. The diagnosis of meningococcemia can be made by the growth of the organism from blood cultures. Treatment should begin when the diagnosis is suspected and should not be delayed by the doctor’s waiting for positive cultures. Obtaining fluid from a petechial spot and staining it in the laboratory can assist in quickly seeing the organism.
Laboratory tests:
- Meningococcemia can be confirmed with blood culture, lumbar puncture, and a Gram stain of lesional skin biopsy or aspirate specimens.
- Blood culture
- Perform the blood culture before the administration of antibiotics, if possible, unless this delays the start of treatment.
- In meningococcemia, organisms have been isolated by blood culture in almost 100% of patients, yet the results are not available for 12-24 hours.
- Throat culture
- A throat culture should be obtained; however, the diagnosis of meningococcemia cannot be made solely based on a positive result from throat culture because asymptomatic colonization is not uncommon.
- Complement deficiencies should be sought for complicated infections and recurrent or familial disease.
- CBC with differential
- Skin biopsy and gram stain
- Urinalysis
- Clotting studies (PT, PTT)
Treatment / Drugs:
Immediate treatment of a suspected case of meningococcemia begins with antibiotics that work against the organism. Possible choices include penicillin G, ceftriaxone (Rocephin), cefotaxime (Claforan), or trimethoprim/sulfamethoxazole (Bactrim, Septra). Aqueous penicillin G may be given to both children and adults. Chloramphenicol may be given in cases of penicillin allergy.
Medical Management:
- The most important measure in treating meningococcemia is early detection and rapid administration of antibiotics. Penicillin G is the antibiotic of choice for susceptible isolates. A third-generation cephalosporin (eg, cefotaxime, ceftriaxone) can be used initially in septic patients while the diagnosis is being confirmed.
- Intensive supportive care is required for patients with fulminant meningococcemia. Components of treatment include antibiotic therapy, ventilatory support, inotropic support, and intravenous fluids. Central venous access facilitates the administration of massive amounts of volume expanders and inotropic medications needed for adequate tissue perfusion. If DIC is present, fresh frozen plasma may be indicated.
Surgical management:
- Early in the course of tissue injury, conservative therapy is recommended until a distinct line of demarcation is apparent between viable and nonviable tissue.
- Once the patient is stable, debridement of all necrotic tissue is essential and may necessitate extensive removal of skin, subcutaneous tissue, and muscle.
- Large defects may be covered using microvascular free flaps or skin grafts.
- The use of artificial skin can spare the patient immediate use of autograft sites, which frequently are limited.
- Avoid amputation whenever useful function of a limb can be salvaged.
- Poor tissue perfusion may also lead to dental complications that require extensive extraction of severely affected teeth.
