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Meningococcal infection
Last reviewed: 05.07.2025
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Meningococcal infection is an acute anthroponotic infectious disease with an aerosol mechanism of transmission of the pathogen, which is characterized by fever, intoxication, hemorrhagic rash and purulent inflammation of the meninges.
ICD-10 codes
- A39. Meningococcal infection.
- A39.1. Waterhouse-Friderichsen syndrome, meningococcal adrenalitis, meningococcal adrenal syndrome.
- A39.2. Acute meningococcemia.
- A39.3. Chronic meningococcemia.
- A39.4. Meningococcemia, unspecified.
- A39.5. Meningococcal heart disease. Meningococcal: carditis NEC; endocarditis; myocarditis; pericarditis.
- A39.8. Other meningococcal infections. Meningococcal: arthritis; conjunctivitis; encephalitis; neuritis, retrobulbar. Postmeningococcal arthritis.
- A39.9. Meningococcal infection, unspecified. Meningococcal disease NOS.
What causes meningococcal infection?
Meningococcal disease is caused by the meningococcus bacteria (Neisseria meningitidis), which causes meningitis and septicemia. Symptoms of meningococcal disease, usually acute, include headache, nausea, vomiting, photophobia, drowsiness, rash, multiple organ failure, shock, and disseminated intravascular coagulation. Diagnosis is based on clinical manifestations of infection and confirmed by culture. Treatment of meningococcal disease is with penicillin or third-generation cephalosporins.
Meningitis and septicemia account for more than 90% of meningococcal infections. Infectious lesions of the lungs, joints, respiratory tract, genitourinary organs, eyes, endocardium and pericardium are less common.
The incidence of endemic disease worldwide is 0.5-5/100,000 population. The incidence increases in winter and spring in temperate climates. Local outbreaks of infection occur most frequently in the region of Africa between Senegal and Ethiopia. This region is called the meningitis zone. Here the incidence rate is 100-800/100,000 population.
Meningococci may colonize the oropharynx and nasopharynx of asymptomatic carriers. The carrier most likely becomes ill under the influence of a combination of factors. Despite the high recorded carrier frequency, the transition from carrier to invasive disease is rare. It most often occurs in people who have not been infected before. Usually, the infection is transmitted by direct contact with the respiratory secretions of the carrier. The carrier frequency increases significantly during epidemics.
Once the meningococcus enters the body, it causes meningitis and acute bacteremia in both children and adults, leading to diffuse vascular effects. The infection can quickly become fulminant. It is associated with a mortality rate of 10-15% of cases. In 10-15% of recovered patients, serious sequelae of the infection develop, such as permanent hearing loss, slowed thinking, or loss of phalanges or limbs.
Children aged 6 months to 3 years are most frequently infected. Other risk groups include teenagers, conscripts, students recently living in a dormitory, people with defects in the complement system, and microbiologists working with meningococcal isolates. Infection or vaccination leaves behind type-specific immunity.
Where does it hurt?
How is meningococcal infection diagnosed?
Meningococci are small, gram-negative cocci that are readily identified by Gram staining and other standard bacteriologic identification methods. Meningococcal disease is diagnosed by serologic methods, such as latex agglutination and coagulation tests, which allow rapid preliminary diagnosis of meningococci in blood, cerebrospinal fluid, synovial fluid, and urine.
Both positive and negative results must be confirmed by culture. PCR testing can also be used to detect meningococci, but this is not cost-effective.
What do need to examine?
How to examine?
What tests are needed?
Who to contact?
How is meningococcal infection treated?
Until reliable results are obtained on the identification of the causative agent, immunocompetent adults suspected of having meningococcal disease are given a third-generation cephalosporin (eg, cefotaxime 2 g IV every 6 hours or ceftriaxone 2 g IV every 12 hours plus vancomycin 500 mg IV every 6 or 1 g IV every 12 hours). In immunocompromised individuals, coverage for Listeria Monocytogenes should be considered by adding ampicillin 2 g IV every 4 hours. If meningococci are reliably identified as the causative agent, penicillin 4 million units IV every 4 hours is the drug of choice.
Glucocorticoids reduce the incidence of neurologic complications in children. If antibiotics are prescribed, the first dose should be given with or before the first dose of antibiotics. Meningococcal disease in children is treated with dexamethasone 0.15 mg/kg intravenously every 6 hours (10 mg every 6 hours for adults) for 4 days.
How is meningococcal disease prevented?
Close contacts of patients with meningococcal disease are at high risk of developing the infection and should receive prophylactic treatment for meningococcal infection with an antibiotic. The drugs of choice are rifampin 600 mg orally every 12 hours for a total of 4 doses (for children over 1 month, 10 mg/kg orally every 12 hours for a total of 4 doses; for children under 1 month, 5 mg/kg orally every 12 hours for a total of 4 doses) or ceftriaxone 250 mg intramuscularly for 1 dose (for children under 15 years, 125 mg intramuscularly for 1 dose) or a single dose of a fluoroquinolone for adults (ciprofloxacin or levofloxacin 500 mg or ofloxacin 400 mg).
In the United States, a meningococcal conjugate vaccine is used. The meningococcal vaccine contains 4 of the 5 meningococcal serogroups (all except group B). People at high risk for meningococcal disease should be vaccinated. The vaccine is recommended for military recruits traveling to endemic areas, people with laboratory or industrial exposure to aerosols containing meningococci, and patients with functional or actual asplenia. Vaccination should be considered for college applicants, especially those who will be living in dormitories, people with previous exposure to patients, health care and laboratory personnel, and immunocompromised patients.
Generalized meningococcal infection is a reason for hospitalization. Carriers identified in the patient's environment are isolated and sanitized. According to epidemiological indications, vaccines are administered to prevent meningococcal infections:
- dry meningococcal group A polysaccharide vaccine in a dose of 0.25 ml for children aged 1 to 8 years and 0.5 ml for children aged 9 years, adolescents and adults (subcutaneously once);
- polysaccharide meningococcal vaccine of groups A and C in a dose of 0.5 ml - for children from 18 months (according to indications - from 3 months) and adults subcutaneously (or intramuscularly) once;
- Mencevax ACWY in a dose of 0.5 ml - for children from 2 years of age and adults subcutaneously once.
What are the symptoms of meningococcal infection?
Patients with meningitis often report fever, headache, and neck stiffness. Other symptoms of meningococcal disease include nausea, vomiting, photophobia, and lethargy. Maculopapular and hemorrhagic rashes often appear after the onset of illness. Meningeal signs are often evident on physical examination. Syndromes associated with fulminant meningococcemia include Waterhouse-Friderichsen syndrome (septicemia, advanced shock, cutaneous purpura, and adrenal hemorrhage), sepsis with multiple organ failure, shock, and DIC. Rarely, chronic meningococcemia causes recurrent mild symptoms.
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