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Section 3. Summaries of Infectious Diseases
Meningococcal Infections
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Susceptibility Testing
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: Invasive infection usually results in meningococcemia, meningitis, or both. Onset often is abrupt in meningococcemia with fever, chills, malaise, prostration, and a rash that initially may be macular, maculopapular, or petechial. In fulminant cases (Waterhouse-Friderichsen syndrome), purpura, disseminated intravascular coagulation, shock, coma, and death can ensue within several hours despite appropriate therapy. The signs and symptoms of meningococcal meningitis are indistinguishable from signs and symptoms of acute meningitis caused by Streptococcus pneumoniae or other meningeal pathogens. Less common manifestations include pneumonia, febrile occult bacteremia, conjunctivitis, and chronic meningococcemia. Invasive meningococcal infections can be complicated by arthritis, myocarditis, pericarditis, and endophthalmitis.
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ETIOLOGY: Neisseria meningitidis is a gram-negative diplococcus with at least 13 serogroups. Strains belonging to groups A, B, C, Y, and W-135 are implicated most commonly in systemic disease. The distribution of meningococcal serogroups in the United States has shifted in recent years. Serogroups B, C, and Y each account for approximately 30% of reported cases, but serogroup distribution may vary by location and time. Serogroup A has been associated frequently with epidemics elsewhere in the world, primarily in sub-Saharan Africa. Worldwide, serogroup W-135 causes less than 5% of reported cases. In 2000, the first epidemic of serogroup W-135 was reported in association with the Hajj in Saudi Arabia, and in 2002, a serogroup W-135 epidemic was reported in sub-Saharan Africa.
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EPIDEMIOLOGY: Asymptomatic colonization of the upper respiratory tract provides the source from which the organism is spread. Transmission occurs from person to person through respiratory tract droplets. Since introduction of Haemophilus influenzae type b immunization for infants, N meningitidis has become one of the 2 leading
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