Meningococcemia (cont.)

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How is meningococcemia diagnosed?

The diagnosis may be suggested from the patient's history and physical exam, although definitive diagnosis requires laboratory testing. Because the disease can progress rapidly, treatment should be started promptly without waiting for laboratory test results. Meningococcemia is diagnosed by culturing N. meningitidis from a sample of blood. The bacteria grow in one to two days in most cases, and biochemical methods are used to identify them as N. meningitidis. Samples of the growth can also be stained and examined under the microscope to detect the characteristic double kidney bean appearance of the bacteria, although additional biochemical tests are performed to confirm the identification of the organism. Once the organism is growing on culture medium, tests are done to determine which antibiotics are likely to kill the bacteria.

In some instances, skin biopsies from the rash can reveal the organisms under the microscope, but this is difficult and a negative result is not a reliable means of ruling out meningococcemia. Other investigators have occasionally used a PCR (polymerase chain reaction) laboratory test to detect N. meningitides in the blood, although the test was developed for spinal fluid. The drawbacks of PCR are that it cannot determine how susceptible the bacteria are to specific antibiotics and that the test may not be available in all hospital laboratories.

What is the treatment for meningococcemia?

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Meningococcemia is a very severe bacterial infection often requiring intensive-care monitoring. The most important treatment for meningococcemia is early intravenous antibiotic therapy. Antibiotics must be started as soon as meningococcemia is suspected. A third-generation cephalosporin (ceftriaxone [Rocephin], cefotaxime [Claforan]) is the initial treatment of choice. Once cultures with sensitivities to antibiotics are known, the antibiotic regimen may be adjusted.

In addition to intravenous antibiotics, patients in the intensive care will likely require intravenous fluids and sometimes medications (vasopressors) to help maintain and support an adequate blood pressure. Some patients may require ventilator support if they develop respiratory distress.

Medically Reviewed by a Doctor on 1/31/2014

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