acute meningococcal

Question 1

key pointsmeningococcal peads

Answer 1

IV ceftriaxone/cefotaxime should be given as soon as meningococcal disease is suspected. If unavailable, give benzylpenicillin
If IV access cannot be obtained within 15 minutes, administer IM or via intraosseus
Collect blood cultures prior to antibiotics if possible, but do not delay antibiotic administration

Question 2

presentations of meningococcal disease

Answer 2

Acute meningococcal disease may present as severe sepsis with a progressive non-blanching petechial/purpuric rash, or meningitis with or without a rash
Rarer presentations include septic arthritis, pneumonia, pharyngitis and occult bacteraemia

Question 3

Asessment - acute meningococcal peads

Answer 3

History
Rapid onset (<12 hours) of headache, loss of appetite, nausea, vomiting, sore throat and coryza
Fever
Infants may have reduced feeds, irritability
Leg pain or myalgia
Examination
Signs of sepsis: see Sepsis
Abnormal skin colour (pallor or mottling) and/or cool peripheries
Late signs (>12 hours)
Altered conscious state
Neck stiffness, headache, photophobia, bulging fontanelle
Non-blanching rash: petechiae/purpura
Note: a blanching rash does not exclude meningococcal disease (can initially be macular or maculopapular)

Question 4

red flags- meningococcal disease peads

Answer 4

<12hours onset of HA, N/V, sore throat and coryza
signs of sepsis
Neck stiffness, photophobia
Non blanching rash: petechiea/purpura

Question 5

mng - meningococcal peads (ix and tx)

Answer 5

Investigations should NOT delay antibiotic administration

Blood (or intraosseus):
Culture: should be obtained prior to antibiotic administration if possible.
PCR (separate EDTA tube, minimum volume 0.2 mL)
CSF (once initially stabilised and no contraindication to lumbar puncture): Gram stain (Gram negative diplococci), biochemistry, culture, and meningococcal PCR
Treatment
Resuscitate as appropriate

Antimicrobial recommendations may vary according to local antimicrobial susceptibility patterns; please refer to local guidelines

Ceftriaxone 100 mg/kg (max 4 g) IV daily or

Cefotaxime 50 mg/kg (max 2 g) IV 12 hourly (week 1 of life), 6-8 hourly (week 2-4 of life), 6 hourly (>week 4 of life)

If no IV/intraosseus access, give IM (may need two injections due to volume/muscle size and repeat the dose once IV access available)
If ceftriaxone/cefotaxime unavailable, administer benzylpenicillin 60 mg/kg IV 12 hourly (week 1 of life) 6 hourly (week 2–4 of life) 4 hourly (>week 4 of life) (max 2.4 g)
Duration of antibiotics is 5 days

If meningococcal infection is not yet confirmed treat as per Sepsis

For additional management see Sepsis and Meningitis and encephalitis

Ward management / other treatment considerations
Isolation
Meningococcal disease is spread person-to-person by respiratory droplets.
Patients should be isolated and droplet precautions continued for 24 hours after administration of appropriate antibiotics.

Notification
All cases of presumed or confirmed meningococcal disease require immediate notification to the local state authority:

NSW: Public Health Units of local Hospital & Health Service by telephone 1300 066 055 and PHU form
QLD: Public Health Units of local Hospital & Health Service by telephone ( list of PHUs )
VIC: Department of Human Services by telephone – 1300 651 160 ( DHHS notification procedure)
WA: Department of Health PHU
Chemoprophylaxis
Chemoprophylaxis should be given to contacts as soon as possible

Vaccination

MenB vaccine
MenC vaccine
MenACWY (quadrivalent) vaccine