Meningococcemia Symptoms & Signs
Signs and symptoms of meningococcemia include
- joint pains, and
- body aches.
Signs and symptoms of meningococcemia include
Meningococcemia is a bacterial infection of the blood due to Neisseria meningitidis, also called meningococcal bacteremia or meningococcal sepsis. As the name suggests, this bacterium is best known for causing meningococcal meningitis, which occurs in up to 20% of those with meningococcemia. Up to 75% of those with meningococcal meningitis will also have bacteremia.
Many bacteria can cause bloodstream infections (septicemia), including staphylococci, Streptococcus B, or Streptococcus A. In addition, other bacteria can cause meningitis, including Streptococcus pneumoniae or leptospirosis. However, N. meningitidis is the commonest cause of bacterial meningitis in the U.S. It is more readily contagious from person to person than these other bacteria and causes rapidly progressive and severe disease (fulminant meningococcemia). Rates of infection are typically highest in older children and adolescents, although there are reports of meningococcemia in all age groups. People with deficiency of the complement immune system and those taking complement inhibitors (eculizumab [Soliris]) are at high risk for severe meningococcal disease, even if they are vaccinated.
The case-fatality rate of meningococcal disease is high, up to 15%, even with antibiotic treatment; it is up to 40% with bacteremia. Up to 20% who survive have disabilities like deafness, neurologic problems, or amputations.
N. meningitidis, or meningococcus, is a gram-negative bacillus. Under the microscope, the bacteria usually appear in pairs (diplococcus), like two small kidney beans side by side. Meningococcemia is another term for widespread bloodstream infection.
Humans are the only known source (reservoir) for meningococcal infection. Some people can harbor the bacteria in their throats and not get sick (a "carrier" state), but others develop infection. Either can transmit the bacteria.
There are several different types (at least 12 serogroups) of N. meningitidis.
Children and adolescents 5 to 19 years of age are at highest risk for meningococcemia. Newborns acquire antibodies from their mothers via the placenta, although these antibodies fade after a few weeks or months. Toddlers are not immune, and there have been several exposures in day care settings. As children age, they gradually gain immunity to meningococcal strains by coming into contact with milder strains of the bacteria. However, because this immunity is imperfect, it is still possible for adults to get meningococcal disease. In the U.S., medical professionals routinely administer meningococcal vaccine to children in the preteen and teen years.
HIV infection is a risk factor for invasive meningococcal infection. On Aug. 16, 2016, after 24 cases of meningitis arose in men who have sex with men (MSM), two of whom had HIV, California public health officials issued an advisory recommending meningococcal vaccination of all HIV-infected people and MSM who planned to travel to the area. This was the largest meningococcal outbreak in MSM in the U.S.
The complement part of the immune system is critical in fighting off meningococcal disease. Patients who have a history of a specific genetic deficiency in the complement system, or who are taking an anti-complement drug for certain diseases, are at high risk for severe disease. The spleen is necessary for an effective immune response against encapsulated bacteria, so people are at higher risk for fulminant meningococcemia if they have had their spleens taken out (asplenia) or have spleens that function poorly (hyposplenism).
People who have been in close contact with an infected person for a long time are at increased risk to acquire the disease. People who live together in close quarters, such as military barracks or college dormitories, are at special risk for disease because one infected person can spread the disease to many others. One study showed that the attack rate in household contacts was 500 times greater than that of the general population.
In some parts of the world, outbreaks of meningococcal disease occur regularly. This is true of a group of countries in sub-Saharan Africa (the "meningitis belt") where epidemics occur every five to 10 years, with an attack rate of up to 1,000 cases per 100,000 population (compared to up to three per 100,000 population in the rest of the world).
Outbreaks have occurred during the Islamic Hajj pilgrimage. Over 2 million Muslims from over 180 countries visit Saudi Arabia during the Hajj. The pilgrimage is long and arduous. Heat, throat irritation by dust, dense overcrowding, and inadequate hygiene contribute to infection. Saudi Arabia now requires proof of meningococcal (ACWY) vaccination on an International Certificate of Vaccination or Prophylaxis before admitting pilgrims. This has greatly reduced the occurrence of meningitis.
Infected patients initially experience
Once symptoms appear, the disease usually gets rapidly worse over several hours. In a minority of cases, symptoms continue at a low-grade level for several days.
If meningitis is present,
Common meningococcemia symptoms
Severe meningococcemia symptoms
Although meningococcemia refers to an infection of the bloodstream.
A patient's history and physical exam may suggest a diagnosis of meningococcemia, although definitive diagnosis requires laboratory testing. Because the disease can progress rapidly, patients should start treatment promptly without waiting for laboratory test results. Health care professionals diagnose meningococcal infection by culturing N. meningitidis from blood cultures. The bacteria grow in one to two days in most cases, and medical professionals use biochemical methods 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 (diplococcus) 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, medical professionals perform tests to determine which antibiotics are likely to kill the bacteria (susceptibility testing) because increased resistance to several antibiotics has been documented.
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. Investigators have used a PCR (polymerase chain reaction) laboratory test to detect N. meningitidis in the blood, although they developed the test for spinal fluid. The drawbacks of PCR are that it cannot determine how susceptible the bacteria are to specific antibiotics and that the test is not available in all hospital laboratories.
These complications could include
There are several ways to prevent meningococcemia.
Meningococcal disease is vaccine preventable.
In people ages 2 months to 10 years old, physicians recommend conjugate vaccine for
In adults, the recommendations for conjugate ACWY-135 are as below:
In some situations where an individual remains at high risk, doctors perform revaccination after five years. Doctors may also consider serogroup B vaccine at age 16-18, however, serogroup B vaccine is definitely recommended in teens age 16-23 and adults as below:
Health care providers will take special care in giving serogroup B vaccine to infants and children with poor spleen function or who live with HIV. Those ages 2-23 months should receive the Menveo brand of serogroup B vaccine or wait until age 2 to receive Menactra. At that time, they should receive the conjugate pneumococcal vaccine (PCV-13) first, followed by Menactra. This is because the latter may interfere with development of pneumococcal antibodies.
People taking eculizumab (Soliris) remain at high risk for invasive meningococcal disease, and physicians will monitor them for symptoms even if vaccinated.
Outbreaks of meningococcemia or meningococcal disease occur sporadically around the world but occur more predictably in sub-Saharan Africa. Health care providers should administer the ACWY conjugate vaccine to travelers visiting these areas. Those with special risk factors above should get the serogroup B vaccine. As mentioned above, Saudi Arabia requires proof of vaccination for travelers during the Hajj.
In addition to vaccination, respiratory etiquette (cover coughs and sneezes with the elbow or disposable tissue) and hand hygiene (frequent washing with soap and water or ethanol-based hand sanitizer) is very helpful in preventing infections in general.
The Centers for Disease Control and Prevention (CDC) is a good source of information on N. meningitidis and the meningococcal vaccine: http://www.cdc.gov/meningococcal/. Travelers should consult their physician and the CDC web site (http://wwwnc.cdc.gov/travel) for additional information.