Meningococcal Disease

Question 1

Causative organism of meningococcal disease

Answer 1

• Neisseria meningitidis – gram negative diplococcus

Question 2

Clinical features of meningococcal disease

Answer 2

• Rigors
• Fever
• Leg pain
• Cold hands and feet
• Non-blanching purpura/petechiae(> 2mm, not always seen)
• Drowsiness/altered conscious state
• Rapid progression of disease
• Signs of sepsis
• Classic signs of meningitis: Neck stiffness, headache, photophobia, bulging fontanelle (late sign >12 hours)

Question 3

What is the classic test for seeing if a rash blanches?

Answer 3

Glass test - press glass against rash to see if it blanches

Question 4

What are the ways meningococcal disease can present -

common and rare?

Answer 4

• Meningitis +/- sepsis or rash
• Meningococcaemia i.e. sepsis with progressive non-blanching petechial/purpuric rash

Rare:
• Arthritis
• Pneumonia
• Pharyngitis

Question 5

What is the acute Mx of meningococcal disease

Answer 5

• Obtain IV access within 15 mins for IV abx (if not, IM/IO)
• 3rd generation cephalosporins (ceftriaxone, cefotaxime) or penicillin (if sensitive)
  
  • Gentamicin doesn’t cross BBB
  • 5-7 days abx
• Intensive supportive management
• Isolation until 24h after abx
  
  • Spread person-person via droplets
• Notifiable disease
• Chemoprophylaxis for contact within 24 hours (rifampicin) to minimise nasopharyngeal colonisation (ceftriaxone for pregnant women)

Question 6

Complications of meningococcal disease

Answer 6

• Shock
• DIC
• SIADH
• Adrenal haemorrhage
• Gangrene
• Neurodevelopmental sequelae
• Hearing loss