While meningococcal sepsis is the most devastating form of sepsis, with a high rate of mortality and sequelae caused by endovascular inflammation and thrombosis, meningococcal meningitis has a relatively low rate of mortality and neurological sequelae compared to other types of bacterial meningitis 21, 172, 419. The uk joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. Saharan africa, with recurrent epidemics of group a disease. Narrow pulse pressure warm shock wide pulse pressure start noradrenaline 0. A simple cheap meningococcal sepsis prognostic score based on readily available, rapid, objective laboratory base excess and platelet count was developed and validated retrospectively. In 1919 herrick stated with respect to meningococcal infections no other infection so quickly slays 3, a statement that still holds true 80 years later.
Pathogenesis, therapy, and prevention of meningococcal sepsis. Evolutionary history was inferred using the neighborjoining method. Overall, the mortality for meningococcal infection is approximately 510%, but can reach as high as 2040% in severe sepsis meningitis. Meningococci can also cause other problems, including a serious bloodstream infection called sepsis meningococcal infections can spread from person to. Jul 16, 2018 even when the disease is diagnosed early and adequate therapy is instituted, the casefatality rate in meningococcal meningitis ranges from 510%. Neisseria meningitidis is the leading cause of bacterial meningitis in children and young adults in the united states, with an overall mortality rate of percent, and it is the second most common cause of communityacquired adult bacterial meningitis. Apr 08, 2020 meningococci can also cause other problems, including a serious bloodstream infection called sepsis. Nasopharyngitis preceded meningococcemia at an average of 78% of patients.
Combining this paper in a new metaanalysis table 4 gave a pooled rr of 0. Pdf pathophysiology of meningococcal meningitis and septicaemia. However, the mortality of meningococcal disease remains 10% to 15% for all cases, and is up to 40% in patients with severe sepsis. Meningitis vaccine project with the menafrivac vaccine against disease.
Bacterial meningitis amsterdam umc vrije universiteit amsterdam. Pdf sepsis caused by neisseria meningitidis meningococcus is a rapidly progressing, lifethreatening disease. Living in close quarters, such as in college dorms or military settings. Consider meningitis or meningococcal sepsis if any of the following are present. This micrograph depicts the presence of aerobic gramnegative neisseria meningitidis diplococcal bacteria. Aug 20, 2015 meningococcal disease usually occurs within 114 days of acquisition.
Quadrivalent meningococcal conjugate vaccines 4vmencv is a combination vaccine and protects against groups a, c, y and w strains for meningococcal diesease. Chapter meningococcal infection september 2019infection. Meningococcal meningitis world health organization. This bacterium is not normal flora, but a pathogenic organism that may be present in a large percentage of the population without causing disease. Early suspicion of the diagnosis is vital so that parenteral antibiotic treatment can be administered as soon as possible to reduce the complications of. An infection arising in the respiratory tract linked to aggressive n meningococcus strains. Pdf pathophysiology of meningococcal meningitis and. Meningitis bacterial and meningococcal septicaemia in. Jul 31, 20 a simple cheap meningococcal sepsis prognostic score based on readily available, rapid, objective laboratory base excess and platelet count was developed and validated retrospectively.
Factors that increase the risk of invasive infection include young age incidence is highest in infants, followed by. It also appeared in the abg interpretation scenario for question 3. Acute management of suspected meningococcal disease. Symptoms of meningococcal disease can first appear as a flulike illness and rapidly worsen. The majority of deaths occur in the first 24 hours, before the commencement of specialist care. Meningococcal disease has two main clinical presentations. This bep score should facilitate sepsis clinical trials, allowing study of the relevant human animal model. Sepsis leads to shock, multiple organ failure and death especially if not recognized early and treated promptly. Most patients with meningococcal meningitis, caused by the gramnegative diplococcus neisseria meningitidis, recover completely if appropriate antibiotic therapy is instituted promptly. This vaccine is included on the nip free national immunisation program for babies at 12 months of age. The two most common types of meningococcal infections are meningitis and septicemia.
Current regimens of treatment of meningococcal sepsis include prompt. Summary bacterial meningitis is a lifethreatening condition that can affect all ages, but is most common in babies and children. Treatment and prevention of meningococcal infection uptodate. See clinical manifestations of meningococcal infection. Together, our findings demonstrate that c5ar1 drives the pathophysiology associated with meningococcal sepsis and provides a promising target for adjunctive therapy. Aug, 2019 patients with acute meningococcemia may present with 1 of 3 syndromes. Meningococcal disease may present with a variety of manifestations, ranging from a transient flulike illness to fulminant disease with rapid clinical deterioration. These symptoms can occur discretely or can blend into. While best known as a cause of meningitis, it can also result in sepsis, which is an even more damaging and dangerous condition. A photomicrograph of neisseria meningitidis recovered from the urethra of an asymptomatic male. Epidemiology transmitted by droplet to family members or close exposures. Transmission occurs through close contact, droplets, or direct contact with respiratory secretions. The most common infection is meningitis, which is an inflammation of the thin tissue that surrounds the brain and spinal cord. Some states in australia are offering meningococcal vaccines to adolescents.
Mar 25, 20 nasopharyngitis preceded meningococcemia at an average of 78% of patients. Pdf bacterial meningitis is an inflammation of the meninges, including the pia, arachnoid, and subarachnoid space. It has a high mortality rate if untreated but is vaccinepreventable. Jul 21, 2011 meningococcal meningitis has special relevance in the armed forces due to overcrowded living in regimental centers and during wars. The article on meningococcal septicaemia would be more appropriately covered here. Meningococcal infections can spread from person to person.
May 05, 2010 the majority of deaths occur in the first 24 hours, before the commencement of specialist care. Babies and young children are most at risk of getting meningitis, but it can affect anyone. Early suspicion of the diagnosis is vital so that parenteral antibiotic treatment can be administered as soon as possible to reduce the complications of infection. Meningococcemia is inherently meningococcal sepsis, which, like other septic conditions, appears febrile fever and severe intoxication syndrome with manifestations of multiple organ pathology. Seek medical attention immediately if you or your child develops symptoms of meningococcal disease. As well as infecting the meninges, meningococcal bacteria can also cause septicaemia. Meningococci are a type of bacteria that cause serious infections. Outline the diagnostic features, complications and treatment of patients with meningococcal sepsis. If clinical picture is suggestive of meningococcal sepsis seek senior medical advice immediately for retrieval, contact rsq retrieval services queensland 0 799 127 notify public health unit phu within 6 hours see phu contact details below for clinical advice child. Chapter meningococcal infection meningococcal infection september 2019 a small minority of individuals develop invasive disease after an incubation period of 34 days range 110 days. Meningococcal sepsis has a greater mortality rate than meningococcal meningitis, but the risk of neurologic sequelae is much lower. The purpose of this study was to evaluate associations between longterm physical and psychological outcome variables in patients who survived meningococcal septic shock mss in childhood. Invasive meningococcal disease is most common in infants. A case of meningococcal sepsis and meningitis with complement 7.
Meningococcemia is inherently meningococcal sepsis, which, like other septic conditions, appears febrile fever and severe intoxication syndrome with manifestations of. It is also more common in teenagers and young adults between the ages of 15 and 24. Defeating meningitis by 2030 world health organization. Meningococcal disease remains a significant illness with an overall mortality of around 8%. The meningococcus lives in the throat of 510% of healthy people.
Meningitis and septicaemia in adults meningitis is an infection of the meninges the membranes that cover the brain and spinal cord. Combining the passive and active surveillance data was justified because there were. Unlike adults, sepsis in childhood most frequently occurs in previously healthy children. Public health management of sporadic cases of invasive. Meningokokkenmeningitis en sepsis lci richtlijnen rivm. Septicaemia or sepsis is a life threatening condition that arises when the bodys response to an infection injures its own tissues and organs. More rarely other forms of invasive meningococcal disease are encountered. Meningitis bacterial and meningococcal septicaemia in children and young people qs19. One of the most dramatic features of severe meningococcal sepsis is the occurrence of widespread purpura fulminans, 23 with thrombosis and haemorrhagic necrosis in large areas of skin and in extreme cases with infarction and gangrene of limbs and digits. Once the bacteria enter the blood stream and the host is unable to clear the infection rapidly, invasive disease, characterized classically into four presentations, will develop. In this case report, although the patient had both high risk factors, joining the military and complement deficiency, for meningococcal disease at. Jun 29, 2010 the purpose of this study was to evaluate associations between longterm physical and psychological outcome variables in patients who survived meningococcal septic shock mss in childhood.
Normal immune and physiologic responses eradicate pathogens, and the pathophysiology of sepsis is due to the inappropriate regulation of these normal reactions. Nonetheless, the disease still is associated with a high mortality rate and persistent neurologic defects, particularly among infants and young children. Bacterial meningitis and meningococcal septicaemia. Patients with acute meningococcemia may present with 1 of 3 syndromes. Complement c5a receptor 1 exacerbates the pathophysiology of. Meningococcal disease describes infections caused by the bacterium neisseria meningitidis also termed meningococcus. Complement c5a receptor 1 exacerbates the pathophysiology of n. Meningococcal disease causes lifethreatening meningitis and sepsis conditions. Meningococcal septicaemia definition of meningococcal. Most cases of meningococcal disease occur sporadically, with meningococcal disease. Meningococcemia meningococcal sepsis or bloodstream infection is the most severe form of infection characterized by sudden onset of fever, chills, malaise, myalgia, limb pain, prostration, and a macular, maculopapular, petechial, or purpuric rash.
Meningococcal disease an overview sciencedirect topics. Pdf neisseria meningitidis is remarkable for the diversity of interactions that the bacterium has with the human host, ranging from. This opens up new therapeutic approaches to improve the outcome of patients with meningococcal sepsis, allowing the preservation of the bactericidal and opsonizing functions of complement vital for the host defense while specifically intercepting the detrimental actions of the c5ac5ar1 axis. An update of childhood meningococcal sepsis springerlink. Focus may be clear purpura of meningococcal or occult. A patient with sepsis can present with very different symptoms from someone with meningitis. Contextincidence of invasive meningococcal disease has increased recently in persons aged 15 through 24 years. Bacterial meningitis and meningococcal septicaemia nice. We developed an animal model of meningococcal sepsis in transgenic. It has been written with the help of health professionals both in the uk and australia who are involved in looking after patients recovering from meningitis and septicaemia. A total of 120 patients visited the followup clinic age at. Experimental meningococcal sepsis in congenic transgenic mice.
The most recognisable presentations of acute meningococcal disease are sepsis with a progressive nonblanching petechialpurpuric rash, and meningitis with or without sepsis and rash. Someone with meningococcal disease can have meningitis, sepsis, or both at the same time. Worldwide, the most important serogroups of meningococci are groups a, b, c, w and y. Sepsis early management antibiotics early fluid refractory shock cold shock titrate to response max. Meningococcal disease wisconsin department of health.
Sepsis is a serious clinical condition that represents a patients response to a severe infection and has a very high mortality rate. A total of 120 patients visited the followup clinic age at paediatric intensive care unit. Overall, the mortality for meningococcal infection is approximately 510%, but can reach as high as 2040% in severe sepsismeningitis. The meningococcus is the leading cause of meningitis and septicemia in young. The incidence of meningococcal sepsis is highest among young children age 0 4 years and adolescents. Jan 01, 2003 meningococcal disease occurs extensively throughout the world. The clinical manifestations of meningococcal disease can be quite varied, ranging from transient fever and. Defeating meningitis by 2030 report of the first meeting of the technical. Acute meningococcal disease is a lifethreatening infection, it may present as a meningitis andor septicaemia. The risk for meningococcal meningitis is highest among children under the age of 5. Bacterial genetics in meningitis research explorer universiteit. This booklet gives information about after effects. Infection of the meninges and cerebrospinal fluid csf is called meningitis.
Managing meningococcal disease septicaemia or meningitis. Mortality of mss in the netherlands has substantially decreased over recent years from 4. Acute meningococcal disease caused by the bacterium neisseria meningitidis is a potentially devastating cause of severe sepsis. There are no reliable estimates of global meningococcal disease. This article presents a guide to identifying the salient features of meningococcal sepsis and initial management strategies in the primary care setting. When someone has meningococcal meningitis, the bacteria infect the lining of the brain and spinal cord and cause swelling. Meningococcal disease includes meningitis swelling of the tissues that cover the. It is most likely to be fatal when it occurs without meningitis9. Invasive meningococcal disease in adolescents and young adults. Of cases of invasive meningococcal disease, 30%50% present with meningitis alone, 40% have meningitis with bacteremia, and 7%10% have invasion of the bloodstream alone.
Pathophysiology of meningococcal meningitis and septicaemia. Enticingly, pharmacologic c5ar1 blockade enhanced mouse survival and lowered meningococcal burden even when the treatment was administered after sepsis induction. Meningococcal disease is a lifethreatening infection that may progress rapidly, even after appropriate treatment has commenced. Age it is more common in infants, teens, and young adults. The clinical manifestations of meningococcal disease can be quite varied, ranging from transient fever and bacteremia to fulminant disease with death ensuing within hours of the onset of clinical symptoms. The study population was made up of all mss patients requiring intensive care treatment between 1988 and 2001. Doctors call meningitis caused by the bacteria neisseria meningitidis meningococcal meningitis. Meningococcal disease is caused by neisseria meningitidis, a gramnegative bacterium, and is an important cause of sepsis and meningitis. Acute management of suspected meningococcal disease clinical. W is an emerging cause of meningitis and pneumonia in new zealand and around the world. Meningococcal meningitis has special relevance in the armed forces due to overcrowded living in regimental centers and during wars. In 1805, vieusseux reported the first identification of meningococcal disease 1 while the causative organism, neisseria meningitidis, was first isolated in 1887 2.
46 556 944 1144 1443 289 843 794 1442 1006 465 140 966 1465 995 1376 808 1449 1246 526 441 390 1154 284 215 848 1201 366 258 269 605 969 1457 557