Meningococcal Disease – Meningococcal Meningitis and Septicemia: Causes, Symptoms, Transmission, Treatment, and Prevention

Meningococcal disease is a severe bacterial condition that can lead to swelling of the tissues surrounding the brain and spinal cord (causing meningitis) or infection of the bloodstream (leading to meningococcal septicemia). In certain situations, the disease can lead to pneumonia, but this is less common.

Meningitis is characterized by the inflammation of the membranes (meninges) surrounding the brain or spinal cord. This inflammation can begin suddenly (acute) or develop gradually (subacute). The word "meninge" refers to the three membranes that cover the central nervous system. The membranes are thin layers of tissue that provide protection for the tissue contents.

The mortality rate is up to 15% among those infected, and approximately 19% of those who recover may be left with long-term disability, such as damage to the peripheral nervous system or brain, deafness, or loss of limbs.

Mode of transmission

The bacteria spread via airborne droplets or through close contact with an infected person (by kissing, sharing drinks, or living together). It gathers in the nasopharynx, or the post-nasal space, which connects the nasal cavities to the throat. The bacteria are carried by the blood to the membranes (meninges) surrounding the brain or spinal cord. It typically spreads from nearby infected areas, such as the nasal sinuses, or from the cerebrospinal fluid.

Contact includes kissing, sharing drinks, or living together. Up to one in 10 people carry meningococcal bacteria in their nose or throat without getting sick.

Transmission occurs only through human-to-human contact and aerosols. Transmission from animal to human is not possible.

Symptoms

Early symptoms of meningococcal disease are often similar to those of the flu, which can cause a delay in diagnosis and treatment.

Symptoms may include fever (approximately 41°C), headaches, and a stiff neck, sometimes with muscle pain. Nausea, vomiting, and other symptoms may also occur. Skin rashes (petechiae) appear in about half of the people with meningococcal meningitis. Symptoms usually progress very quickly.

Death can occur in as little as 24-48 hours. People who experience these symptoms, especially if they are unusually sudden, progressive, or severe, must be examined by a doctor as soon as possible.

Meningococcal meningitis develops when the bacterium Neisseria meningitidis progresses from initial adherence to the nasopharyngeal mucosa (nose and throat) to the invasion of the deeper layers of the mucosa (submucosa). These bacteria multiply rapidly and can lead to a mild infection (subclinical). However, in approximately 10-20% of cases, the bacteria enter the bloodstream (meningococcemia).

Meningococcemia is characterized by severe and extensive vascular damage, with signs of circulatory collapse and disseminated intravascular coagulation (DIC). Skin rashes appear in about half of the people with meningococcal meningitis. The rash appears in the form of tiny, flat, purplish-red lesions that do not blanch under pressure, and are the result of areas of intravascular bleeding.

Also, swelling or inflammation of the brain (cerebral edema or ventriculitis) or hydrocephalus (buildup of fluid in the brain cavity) can occur. Additional symptoms may include chills, sweating, weakness, loss of appetite, muscle pain (myalgia) in the lower back or legs, or inability to tolerate bright light (photophobia).

Diagnosis

Diagnosing meningococcal disease is somewhat difficult because the symptoms resemble those of other viruses, such as the flu. A correct diagnosis requires the detection of the bacterium Neisseria meningitidis, so blood samples and, possibly, a lumbar puncture (spinal tap) are required to obtain spinal fluid.

These samples will be sent to a laboratory to see if the bacteria can be cultured (grown).

Treatment

Meningococcal disease can be treated with antibiotics, but it is extremely important to receive rapid medical attention to reduce the risk of death. Depending on how severe the infection is, people with meningococcal disease may need other treatments, including:

• Oxygen therapy
• Medications to lower blood pressure
• Surgery to remove dead tissue caused by septicemia
• Wound care for damaged skin caused by septicemia

Even with treatment, 1 in 10 people infected with meningococcal disease will die. Up to one in five survivors will have long-term disabilities, such as limb loss, deafness, nervous system problems, or brain damage.

A range of antibiotics is used to treat meningitis, including penicillin, ampicillin, and ceftriaxone. During epidemics of meningococcal and pneumococcal meningitis, ceftriaxone is the drug of choice.

For suspected sporadic cases of meningococcal disease, isolation of the patient in a hospital/infectious disease ward is necessary, with discharge occurring after clinical recovery.

In the case of household contacts, clinical observation for 10 days from the last exposure and the administration of chemoprophylaxis to all persons in the household environment of the case are required.

In the case of non-household contacts, chemoprophylaxis is instituted in the community frequented by the respective case.

Prevention

The best way to protect yourself against meningococcal disease is through vaccination. In Romania, 2 vaccines are available to prevent meningococcal infections: NIMENRIX (contains serogroups A, C, Y, W-135) and BEXSERO (contains serogroup B). The division into serogroups is based on differences in the composition of the polysaccharide capsule.

Immunity sets in on average 10 days after vaccination and lasts 3-4 years. There are no known contraindications to vaccinating pregnant women.

Meningococcal vaccination is recommended for people at high risk of the disease, including:

• people with low immunity,
• people who are constantly exposed to N. meningitidis strains,
• military personnel
• people traveling to epidemic areas (the "sub-Saharan African meningitis belt" area).

Chemoprophylaxis is mandatory for preventing cases of illness among direct contacts – family members, people in care centers, children in nurseries and kindergartens, and any person exposed to the oral secretions of the person who tested positive. Chemoprophylaxis must be administered as soon as possible, less than 24 hours after identifying the infected person. If chemoprophylaxis is administered after 14 days from the onset of the disease, it is no longer effective.

Prophylactically, drugs prescribed only by a doctor can be administered. Self-medication is prohibited.

References
https://www.nfid.org/infectious-diseases/meningococcal-disease/
https://rarediseases.org/rare-diseases/meningococcal-meningitis/
https://www.health.ny.gov/publications/2168/
https://www.who.int/news-room/fact-sheets/detail/meningitis
https://my.clevelandclinic.org/health/diseases/22442-meningococcal-disease
https://www.romedic.ro/infectii-meningococice-meningita-meningococica
https://www.rmn-diagnostica.ro/meningita-meningococica-si-alte-infectii-meningococice/
https://insp.gov.ro/download/metodologie-supraveghere-boala-meningococica-pdf/
http://srmv.ro/index.php/meningita-meningococica
https://www.cnscbt.ro/index.php/metodologii/boala-meningococica/479-metodologie-supraveghere-boala-meningococica/file
https://www.medichub.ro/reviste-de-specialitate/medic-ro/boala-meningococica-invaziva-importanta-ei-in-patologia-umana-si-prevenirea-acesteia-id-3135-cmsid-51