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Section 3. Summaries of Infectious Diseases
Meningococcal Infections
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Susceptibility Testing
Treatment
Isolation of the Hospitalized Patient
Control Measures
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CLINICAL MANIFESTATIONS
Invasive infection usually results in meningococcemia, meningitis, or both. Onset often is abrupt in meningococcemia, with fever, chills, malaise, myalgia, limb pain, prostration, and a rash that initially can be macular, maculopapular, petechial, or purpuric. The maculopapular and petechial rash is indistinguishable from the rash caused by viral infections, and the purpuric rash may occur in severe sepsis as a result of other bacterial pathogens, including Streptococcus pneumoniae. The progression of disease often is rapid. In fulminant cases, purpura, limb ischemia, coagulopathy, pulmonary edema, shock (characterized by tachycardia, tachypnea, oliguria, and poor peripheral perfusion, with confusion and hypotension late in the disease), coma, and death can ensue in hours despite appropriate therapy. Signs and symptoms of meningococcal meningitis are indistinguishable from signs and symptoms of acute meningitis caused by S pneumoniae or other meningeal pathogens. In severe and fatal cases of meningococcal meningitis, raised intracranial pressure is a predominant presenting feature. The case-fatality rate for meningococcal disease is 10%, and death is associated with young age, absence of meningitis, coma, hypotension, leukopenia, and thrombocytopenia. Less common manifestations include pneumonia, febrile occult bacteremia, conjunctivitis, septic arthritis, and chronic meningococcemia. Invasive meningococcal infections can be complicated by arthritis, myocarditis, pericarditis, and endophthalmitis. A self-limiting postinfectious inflammatory syndrome occurs in less than 10% of cases 4 or more days after onset of meningococcal infection and most commonly presents as fever and arthritis or vasculitis. Iritis, scleritis, pericarditis, and polyserositis are less common manifestations.
Sequelae associated with meningococcal disease occur in 11% to 19% of patients and include hearing loss, neurologic disability, digit or limb amputations, and skin scarring.
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ETIOLOGY
Neisseria meningitidis is a gram-negative diplococcus with
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