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News - Events
Written by Administrator
Friday, 06 May 2005 00:12
Meningococcal disease is a bacterial infection that occurs commonly in
two forms: Inflammation of the membrane covering the brain and
spinal cord (meningococcal meningitis) or a severe blood infection
(meningococcemia). It is an acute disease caused by a gram negative
bacteria Neisseria meningitidis.


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Meningococcal infection is a communicable infection caused by Neisseria meningitis. The


most common disease presentation is meningitis. N meningitis infection may manifest as
chronic meningococcemia that resembles the arthritis-dermatitis syndrome of
gonococcemia; acute meningococcal septicemia (also called meningococcemia) is the
most devastating form of the disease. It can kill more rapidly than any other infectious
disease.

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Meningococcemia is brought about by the spread of the bacteria from the throat to the
bloodstream, causing severe signs and symptoms of hemorrhage and circulatory shock, in
some cases.



 

 

Meningococcemia can be transmitted from person to person via respiratory secretions.

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1. Headache
2. Nausea
3. Vomiting
4. Myalgias (body pain)
5. Arthralgias (joint pain)
6. Fever may increase dramatically with rapid clinical deterioration
7. In fulminant meningococcemia, a hemorrhagic eruption, hypotension and cardiac
depression may be present within hours of initial presentation.
8. Cutaneous manifestations are common and can be the presenting sign of the disease
9. Petechia
10. Urticarial and maculopapular lesions also may occur initially.
11. Pustules, bullae, and hemorrhagic lesions with central necrosis can develop.
12. Altered mental status
13. Neck stiffness
14. Seizures
15. Nerve palsies
16. Gait disturbance
17. Nauseas
18. Unstable vital signs

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1. Complications of Meningococcemia may occur at the time of acute disease or during


recovery phase.
2. Meningococcal arthritis occurs with acute bacteremia in up to 10% of adult cases.
3. Up to 5% of patients develop a non-purulent pericarditis with substernal chest pain
and
dyspnea approximately one week after the onset of illness.
4. Neurologic complications (including peripheral neuropathy) have also been
documented.
5. Long-term complications in patients who survive fulminant meningococcemia are
related to
permanent musculoskeletal sequelae.
6. Amputation may be required for extensive tissue necrosis of the limbs.

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Medical Care:

1. The most important measure in treating meningococcemia is early detection and


rapid
administration of antibiotics.
2. Pennicilin G is the antibiotic of chioce for susceptible isolates.
3. Intensive supportive care is required for patients with fulminant meningococcemia.
a. Antibiotic therapy
b. Ventilatory support
c. Inotrophic support
d. Intravenous fluids

Surgical Care:

Patients who survive the initial acute phase of fulminant meningococcemia are at risk of
serious complications as a result of poor tissue perfusion.

1. Early in the course of tissue injury, conservative therapy is recommended until a


distinct
line of demarcation is apparent between viable and non-viable tissue.
2. Once patient is stable, debridement of all necrotic tissues is essential and may
necessitate extensive removal of skin, subcutaneous tissue, and muscle.
3. Large defects may be covered using microvascular free flaps or skin grafts.
4. The use of artificial skin can spare the patient immediate use of autograft sites,
which
frequently are limited.
5. Avoid amputation whenever useful function of a limb can be salvaged.



 

 

1. Antimicrobial chemoprophylaxis is recommended for close contacts of patients with


meningococcal disease and is the primary means of prevention in the United States.
Close
contacts include household members, day care centers, classmates and anyone
exposed to the patient's respiratory secretions.
2. Institute antimicrobial chemoprophylaxis as soon as possible because the rate of
secondary disease is highest in the first few days after the onset of disease in the
index
case.
3. Current adult recommendations include Rifampicin at 600 mg orally twice daily for 2
days,
or once a day for 4 consecutive days.
4. In addition to Rifampicin, other antimicrobial agents are effective in reducing
nasopharyngeal colonization with N meningitis.
5. Ciprofloxacin and ofloxacin are effective single-dose oral substitutes.
6. Ceftriaxone is available for parenteral single-dose use in children and adults.
7. These medications achieve adequate concentrations in upper respiratory secretions
and
are reasonable alternatives to the multidose Rifampicin regimen for
chemoprophylaxis
Please emphasize:

- Prophylaxis with antibiotics will only be for close contacts of patients.


- No need for masks for settings outside of the hospital
- Antibiotics should not be taken without prescription.

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