Meningococcal blood poisoning

Alternative names 
Meningococcal septicemia; Meningococcemia; Meningococcal bacteremia or bacterial in the blood

Definition
Meningococcemia is an acute (sudden onset) infection of the bloodstream and subsequent vasculitis (inflammation of the blood vessels) caused by the bacteria Neisseria meningitidis.

Causes, incidence, and risk factors

Neisseria meningitidis frequently lives in the upper respiratory tract with no evidence of illness. Some event is thought to trigger the onset of aggressive behavior of the organism and sporadic cases of meningococcemia and meningococcal meningitis appear.

Family members and those closely exposed to an infected individual are at increased risk. The infection occurs more frequently in winter and early spring. It is transmitted from person-to-person by respiratory droplets.

Symptoms
Symptoms may be very few at first, and can include:

     
  • Fever  
  • Petechial (spotty red or purple) rash  
  • Irritability  
  • Appears anxious

Later symptoms and signs can include:

     
  • Appears acutely ill  
  • Changing level of consciousness  
  • Shock  
  • Large areas of hemorrhage and/or thrombosis under the skin

Signs and tests

     
  • CBC with differential  
  • Blood culture  
  • Gram stain of positive culture  
  • Skin biopsy and Gram stain  
  • Urinalysis  
  • Clotting studies (PT, PTT)

Treatment
Patients are often admitted to the intensive care unit of the hospital. Intensive monitoring and treatment are needed.

Supportive measures for shock include:

     
  • IV fluids  
  • Ventilatory support  
  • Medical support of blood pressure

Medications include intravenous (IV) antibiotics to eliminate the infection, and high doses of corticosteroids for shock (must be given early). Clotting factors or platelet replacement may be needed if bleeding disorders develop.

Other treatments:

     
  • Wound care for thrombosed (with Blood clots) areas of skin  
  • Respiratory isolation for first 24 hours, to avoid spread to other patients

Expectations (prognosis)
Early treatment results in a good outcome. When shock develops, the outcome is more guarded. Profound shock, DIC (a severe bleeding disorder), and adrenal collapse all predispose the patient to a poor prognosis with possibility of a death. Patients without Meningitis tend to have a poorer prognosis.

Complications

     
  • Profound shock  
  • Limb loss secondary to clots (thrombosis)  
  • Irreversible shock  
  • Disseminated intravascular coagulopathy (DIC)  
  • Waterhouse-Friderichsen syndrome  
  • Arthritis  
  • Cutaneous vasculitis (inflammation of blood vessels in the skin)  
  • Pericarditis

Calling your health care provider
Call your health care provider immediately or go to the emergency room if your child has symptoms suggestive of meningococcemia.

Prevention

Prophylaxis (preventive antibiotics) for family members and contacts are often recommended. Speak with you health care provider about this option.

A vaccine that covers some but not all strains of meningococcus is available and has been suggested for use by college students. You should discuss the appopriate use of this vaccine with your health care provider.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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