Meningococcal Meningitis - Symptoms, Diagnosis, and Treatment

What Is Meningococcal Meningitis?

The inflammation of the protective layer (meninges) of the brain and spinal cord caused by the bacteria Neisseria meningitis is called meningococcal meningitis. There are 13 subtypes of Meningococcus, of which serotype B most commonly causes meningitis in infants, serotype C in adolescents, and serotype B and Y in older adults.

What Are the Types of Meningococcal Meningitis?

The two most common types of meningococcal infections are meningitis and bloodstream infections.

• Meningococcal meningitis occurs when the bacteria infect the lining of the brain and spinal cord, causing swelling.

• In a meningococcal bloodstream infection, the bacteria enter the bloodstream and damage blood vessel walls, leading to bleeding in the skin and organs.

How Do Individuals Get Meningococcal Meningitis?

Neisseria meningitidis, or Meningococcus, is the second most common cause of bacterial meningitis. It is an anaerobic (does not require oxygen for growth) organism, and it survives in the nose, throat, and other parts like conjunctive, urinary, and genital tracts. The individual may acquire the disease through droplets spread by air or close contact with an infected person. The bacteria then colonize the nose and throat and grow (incubate) for ten days. In rare cases, the bacteria enter the bloodstream and are often eliminated by the body’s immune response. However, if the immune system fails to defend the Meningococcus, it invades the meninges and other body parts, leading to complications.

Who Is at Risk of Developing Meningococcal Meningitis?

• Children who are under five years of age.

• Individuals with compromised immunity.

• Military officials.

• Travelers who move to different countries show an increased prevalence of meningitis.

• Laboratory workers are exposed to different viruses and bacteria.

What Are the Signs and Symptoms?

The infection spreads rapidly to another person during the incubation period (one day to 10 days), and the clinical features are as follows:

• Fever.

• Neck stiffness.

• Changes in the mental state like confusion, etc.

• In infants, lethargy, irritability, feeding refusal, vomiting, and rarely, the soft portion of the skull looks bulged.

• Headache, vomiting, and increased sensitivity to light are other symptoms seen in older adults.

• Pinpoint red dots like a rash (petechiae) occur in the lower legs.

• Severe muscle pain also occurs.

How to Diagnose Meningococcal Meningitis?

• The physician carefully examines the signs like fever, decreased blood pressure, rapid heartbeat, and breathing. Examination of body parts for petechiae is also essential. The doctor also looks for the following classical signs:

1. Kernig Sign: A positive Kernig sign denotes the inability to straighten the leg when the patient is lying flat on the floor. The positive Kernig sign indicates meningitis.

2. Brudzinski Sign: The severe stiffness in patients with meningitis causes bending of knees and hips when the neck is flexed. However, the negative sign does not indicate the absence of meningitis, and it is further evaluated with a neurological examination.

• A blood examination involves assessing the complete blood count and electrolyte levels. In addition, a blood culture is done to detect the bacterial organism.

• A lumbar puncture or spinal tap is a procedure of removing cerebrospinal fluid (CSF) from the bones (vertebrae) of the lower back region for diagnosis. The cerebrospinal fluid shows increased white blood cells (more than 1000 per microliter), high protein content, and decreased glucose level (less than 45 mg/dL). The CSF is also stained with special dyes to detect the bacteria.

• Polymerase chain reaction (PCR) is a rapid test in which the CSF is tested for Meningococcus bacteria. It is a highly effective technique.

• A computed tomography (CT) scan is used in patients above 60 years of age with a previous history of brain and spinal cord diseases and altered mental state.

What Are Similar Diseases?

• Encephalitis is an inflammation of the brain tissue due to bacterial or viral infection. The common symptoms include fever, headache, sensitivity to light, neck stiffness, etc. It requires immediate medical attention to prevent complications.

• Tetanus or lockjaw is a severe spasm of jaw and neck muscles caused by the bacteria Clostridium tetani. It gives rise to fever, severe muscle contraction, pain, swallowing difficulties, and altered heart rate and blood pressure.

• Brain Abscess accumulates pus in brain tissues due to injury or spread of infection from the sinus, tooth, or surrounding tissues. The symptoms are similar to those of meningitis and encephalitis.

How Is Meningococcal Meningitis Treated?

• The first line of treatment involves the intravenous administration of antibiotics. It clears off the Meningococcus from the CSF within six hours.

• Third-generation Cephalosporins are effective against Neisseria meningitidis. It is given in combination with Vancomycin and Ampicillin for individuals over 50 years of age.

• Antibiotics are suggested for seven days. In patients intolerant to the beta-lactam group of antibiotics, Chloramphenicol is advised.

• In patients with increased blood pressure, rapid breathing, and other severe signs, immediate intubation, blood pressure stabilization using vasopressor, and fluid replacement are essential.

What Is the Vaccine for Meningococcal Meningitis?

Meningococcal meningitis poses a serious threat, even with treatment, underscoring the importance of prevention. Vaccination against meningitis is highly effective. In the U.S., three types of meningococcal vaccines are available:

• Meningococcal conjugate vaccines (MenACWY or MCV4): Menveo is approved for individuals aged two months to 55 years, while MenQuadfi is administered to those aged two years or older.

• Serogroup B meningococcal B (MenB) vaccines, Trumenba (MenB-FHbp), and Bexsero (MenB-4C) are both licensed for ages 10-24 but can also be utilized in older patients.

• Pentavalent meningococcal vaccine (MenABCWY): The Pentavalent meningococcal vaccine (MenABCWY), such as Penbraya, is available for those needing both MenACWY and MenB vaccines simultaneously. While they can not prevent all forms of meningococcal disease, these vaccines effectively protect against many strains. Experts advise administering a MenACWY shot to children at age 11, with a booster at age 16. If the initial dose is missed, the vaccine can be given between ages 13 and 15, followed by a booster between ages 16 and 18. A MenB vaccine is recommended for individuals aged 10 or older at high risk.

Can Meningococcal Meningitis Get Complicated?

• Early complications include brain damage, chills, weakness, seizures, and fluid accumulation within the brain (hydrocephalus). It also causes multi-organ failure, Waterhouse-Friderichsen syndrome (failure of adrenal glands), and electrolyte imbalance. The infection also spreads to all body parts, causing septic shock.

• Late complications include hearing loss, chronic pain, increased stress, skin scarring, and neurological disorders.

Conclusion:

Meningococcal meningitis has shown a good prognosis in individuals with early treatment. However, the symptoms worsen due to the negligence of medical attention. Therefore a proper diagnosis by the physician is necessary by evaluating the classic signs of the disease and providing the necessary treatment at the earliest.