Meningococcal meningitis

Meningococcal meningitis is a form of bacterial meningitis caused by the bacterium Neisseria meningitidis (also known as meningococcus), and is most common in children especially those younger than five years.

What causes meningococcal meningitis?

Meningococcal meningitis is caused by a bacterium called Neisseria meningitidis. Its onset is rapid, usually occurring during winter or spring, and is characterised by an upper throat infection or a sore throat.

What are the symptoms of meningococcal meningitis?

Symptoms may include:

- Rash

- Purple, bruise-like areas on the skin (purpura)

- Nausea

- Severe headache

- High fever

- Vomiting

- Sore/stiff neck

- Sensitivity to light (photophobia)

- Changes in mental state

It is important to note that not everyone gets all of the above symptoms. The classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect in infants, children and the elderly. As the disease progresses, patients of any age may have seizures and coma may occur in severe cases.

The rash is usually a late symptom, and indicates septicaemia. It starts as tiny red or brownish blood spots, which look like pin-pricks, and develops into purple bruises or blood blisters. This rash is caused by bleeding under the skin as a result of breakdown of the blood vessel walls.

How is a diagnosis made?

A physical examination by a doctor would reveal a rapid heart rate, low blood pressure, possible rash and low blood pressure. Other tests include:

- White blood cell (WBC) count that is higher than normal.

- A spinal tap to check for spinal fluid would show an increase in white blood cells, low glucose and high protein levels.

- Presence of the meningococcus bacteria would be found in special stains of spinal fluid.

- Meningococcus bacteria grow in blood culture and CSF (cerebral spinal fluid) culture.

- A CT scan of the brain usually does not display any abnormalities.

How is it treated?

An early diagnosis of meningococcal meningitis is vital to avert serious illness or death. Antibiotics like ceftriaxone are prescribed for suspected meningitis and applied via an intravenous (IV) line.

Additional medications may be prescribed to increase spinal fluid pressure. Resistance to penicillin is not common (<6 % in 2013 in SA). It is still the drug of choice for meningococcal meningitis.

What is the prognosis?

The death rate for meningococcal meningitis ranges between 5% and 15% in young children. Adults aged 50 years have the highest death risk. In South Africa the reported mortality rates are between 10 – 14% according to the 2013 GERMS-SA Annual report.

Complications

The exact number of people who experience after-effects or disabilities is not known – about one person in every eight is thought to survive the disease. Not everyone suffers after-effects, and those who do often find they improve with time. Many after-effects will resolve by six to twelve months after the illness.

How can it be prevented?

There are vaccines that provide excellent protection against some forms of meningitis, but all strains of the disease cannot yet be prevented.

Meningococcus has 13 serogroups, of which A, B C, X, Y and W135 are the most common. There are effective vaccines available against groups A, C, W135 and Y. There is currently no vaccine against meningococcus group B or X.

Vaccination is not included in the children’s’ immunization schedule, but should be offered to high risk patients e.g. those who have had a splenectomy and also travellers to endemic areas e.g. the Middle East (Pilgrimage) and Central Africa. Vaccination is not very effective in young children and protection for adults only lasts for three years.

If you have been exposed to meningococcal meningitis, (for example if you are a family member or close contact of someone with the disease) the doctor will give you antibiotics to help prevent you from getting the disease. Vaccination is also an option.

If you do have a contagious form of meningitis, your doctor will let you know when you are no longer contagious and can return to normal activities. Until then you can help prevent spreading the disease by:

- Washing your hands frequently and making sure anyone who has contact with your child does the same.

- Not letting family members share cups or utensils.

- Avoiding contact with saliva, such as by kissing.

When to call the doctor

Consult your GP if you experience any of the symptoms of meningitis.

Seek emergency medical treatment if:

- The symptoms worsen or

- You’ve been in contact with someone who has meningitis. 

Read more: 

New meningitis vaccine for African babies 

Vaccine banishes meningitis epidemic 

Meningitis - from Natural Standard

Revised and reviewed by Dr Andries Dreyer, Pathologist (Clinical Microbiologist), Centre for Tuberculosis (incorporating the NTBRL), National Institute for Communicable Diseases February 2015.