Key points
- Prompt diagnosis and treatment of meningococcal disease are important due to risk of severe morbidity and death.
- Empiric treatment for suspected meningococcal disease is an extended-spectrum cephalosporin, such as cefotaxime or ceftriaxone.
- Treatment with penicillin or ampicillin requires susceptibility testing.
- Maintain awareness that additional treatment may be needed to eradicate nasopharyngeal carriage.
Diagnosis
Clinical features
The two most common syndromes associated with invasive meningococcal disease are meningitis and septicemia.
The most common clinical features of meningococcal meningitis include:
- Fever
- Headache
- Stiff neck
The most common clinical features of meningococcemia include sepsis and rash.
Infants may present with other symptoms:
- Appear to be slow or inactive
- Be irritable
- Feed poorly
- Have a bulging anterior fontanelle
- Have abnormal reflexes
- Vomit
Diagnosis in the setting of increasing cases
Cases of meningococcal disease in the United States have increased sharply since 2021.
People disproportionately affected by the increase include:
- People between the ages of 30 and 60 years
- Black or African American people
- Adults with HIV
It's important to:
- Maintain a heightened index of suspicion for meningococcal disease and recognize who can be affected
- Be aware of atypical presentations
- Recommend vaccination, when indicated
Heightened index of suspicion: This is particularly important among the disproportionately affected populations. However, meningococcal disease may affect people of any age or demographic group.
Atypical presentations: Patients with meningococcal bloodstream infection or septic arthritis may present without the typical meningitis symptoms listed above.
Vaccine recommendations: Stay up to date on the latest guidance for who's recommended to receive meningococcal vaccination. For people with HIV, recommended MenACWY vaccination includes:
- A 2-dose primary series
- Booster doses every 3 to 5 years depending on age
Treatment options
Extended-spectrum cephalosporins used for empirical therapy
Empirical therapy for suspected meningococcal disease should include an extended-spectrum cephalosporin, such as cefotaxime or ceftriaxone.
Treatment with penicillin or ampicillin requires susceptibility testing
Once the microbiologic diagnosis is established, definitive treatment can be continued with an extended-spectrum cephalosporin (cefotaxime or ceftriaxone). Alternatively, if susceptibility of the meningococcal isolate to penicillin is confirmed, treatment can be switched to penicillin G or ampicillin.
Additional treatment may be needed to eradicate nasopharyngeal carriage
Ceftriaxone clears nasopharyngeal carriage effectively after 1 dose.
If ceftriaxone or cefotaxime aren't used for treatment, one of the following is recommended before hospital discharge to eradicate nasopharyngeal carriage:
- A course of rifampin (4 doses over 2 days)
- A single dose of ciprofloxacin or ceftriaxone