Is meningococcemia back?

Meningococcemia is back in the news after it reportedly claimed the life of a woman in Pasay City and that of a young girl in Davao City. The cases are not a cause for alarm but the Infection Control Unit of St. Luke’s Medical Center has issued a health alert to make the public more aware about the ailment and how it can be prevented.

Meningococcemia is an infection of the blood by the bacteria Nesseria meningitides. This is a gram-negative diplococcus and there are five serogroups that cause almost all invasive diseases: A, B, C, Y and W-135.

Meningococcal disease most often occurs in children less than five years old. Forty-five percent of cases occur in children two years and under.

Human beings are the only natural reservoir for meningococcemia. Up to 10 percent of adolescents and adults are asymptomatic transient carriers, most not pathogenic.

The ailment is transmitted person to person by direct contact with droplet secretions.

The incubation period for the ailment is three to four days with a range of two to 10 days. The disease is usually present as either a meningitis (infection that affects the spinal fluid and lining of the brain) or meningococcemia (infection of the blood).

Manifestations in a meningeal infection are similar to other forms of bacterial meningitis, with sudden onset of headache, fever and neck rigidity, accompanied by nausea, vomiting and alerted mental status.

In meningococcemia, there is an onset of fever associated with petechial or purpuric rash with hypotension, shock, bleeding and multi-organ failure. Case fatality rate for meningococcemia is up to 40 percent.

Diagnosis is based on clinical symptoms with the aid of blood culture, CSF culture or antigen test. Gram stain of the blood can give a presumptive diagnosis of meningococcal infection.

If these symptoms are present, you are advised to see a doctor immediately. There are three goals of management: 1) the patient is hydrated and blood pressure is maintained; 2) good oxygenation is maintained; and 3) bacteria are eradicated by giving empiric antimicrobial therapy using Penicillin G, third-generation cephalosporin such as Ceftriaxone, or Chloramphenicol for five to seven days.

Those who have had close contact with meningococcemia patients have to be referred immediately to healthcare providers for appropriate chemoprophylaxis.

Those who need prophylaxis include people who live in the same house as the patient; persons who have had contact with mouth or nose secretions such as through kissing, sharing eating utensils or sharing cigarettes; persons who have done medical treatments such as mouth-to-mouth resuscitation or intubation; and children sharing toys such as in child care centers, family child care homes or nursery schools.

This should be administered ideally within 24 hours after exposure. Prophylaxis administered more than 14 days after the onset of illness is of limited value.

Prophylaxis in adults may be any of the following – Rifampicin, Ciprofloxacin or Ceftriazone. For children, it is either Rifampicin or Ceftriaxone.

To prevent the spread of meningococcemia, the St. Luke’s Infection Control Unit recommends the practice of good hygiene and strict hand washing. Avoid sharing food, beverages, cigarettes or utensils.

Vaccination, which is a single dose quadrivalent polysaccharide, is recommended for certain high-risk groups such as those with immune deficiency (terminal complement component deficiency), spleen problems (asplenia), and those who will travel to an area highly endemic for the disease.

The most important key to the care of such patients includes early detection and prompt treatment. Possible transmission should be assessed rapidly and appropriately to minimize spread.

It is a dangerous illness to have but treatment, preventive drugs and vaccines are available so it is important to know how such an illness is properly handled.