Meningococcal disease is potentially fatal
and should always be viewed as a medical emergency.
Admission to a hospital or health center is necessary.
Antibiotic treatment must be started early in
the course of the disease (in patients with meningitis,
lumbar puncture should be done before starting
antibiotics if possible to ensure the bacteria
will grow in culture). On presentation the appropriate
antibiotics for treatment are dictated by the
differential diagnosis; once the diagnosis is
confirmed, several antibiotic choices are available,
and an infectious disease consultant can be asked
to assist in management.
Occurrence
Sporadic cases and outbreaks of meningococcal
disease occur throughout the world. In the sub-Saharan
African “meningitis belt,” which extends
from Mali to Ethiopia, peaks of serogroup A meningococcal
disease occur regularly during the dry season
(December through June). In addition, major epidemics
occur every 8-12 years. In 2000, a serogroup W-135
epidemic occurred in Saudi Arabia in association
with the Hajj pilgrimage (6). Cases among returning
pilgrims and their families occurred in a number
of countries, including several cases in the United
States. In 2002, a major meningococcal disease
epidemic occurred in Burkina Faso caused by serogroup
W-135. Since 2002, serogroup W-135 has been detected
in several African countries, but it has not caused
major epidemics.
Risk for Travelers
Travelers to sub-Saharan Africa may be at risk
for meningococcal disease. Travelers to the meningitis
belt during the dry season should be advised to
receive meningococcal vaccine, especially if they
will have prolonged contact with local populations.
Prompted by a serogroup A meningococcal disease
outbreak associated with the 1987 Hajj, Saudi
Arabia requires that Hajj and Umrah visitors have
a certificate of vaccination with a tetravalent
(A,C,Y,W-135) meningococcal vaccine before entering.
Clinical Presentation
Sudden onset of fever, intense headache, neck
stiffness, nausea, and often vomiting are common
signs and symptoms of meningococcal sepsis, with
or without meningitis, in persons over the age
of 2 years. These symptoms can develop over several
hours, or they may take 1-2 days. Other symptoms
may include photophobia and an altered mental
status. In infants, a slower onset of signs and
symptoms may occur with nonspecific symptoms,
and neck stiffness may be absent.
Early diagnosis and treatment are critical. If
symptoms occur, the patient should seek medical
care immediately. The diagnosis is usually made
by growing bacteria collected from cerebrospinal
fluid (CSF), detection of the meningococcal antigen
through latex agglutination in fresh CSF, or evidence
of N. meningitidis DNA by polymerase chain reaction.
N. meningitidis can also be identified in blood
cultures. The signs and symptoms of meningococcal
meningitis are similar to those of other causes
of bacterial meningitis, such as Haemophilus influenzae
and Streptococcus pneumoniae. Identification of
the type of bacteria responsible is important
for selection of correct antibiotics. Answers
to frequently asked questions about meningitis
can be found at the following website: http://www.cdc.gov/ncidod/dbmd/diseaseinfo.
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