Skip to main content
SpringerLink
Log in

Guidelines for the Diagnosis and Treatment of Meningococcal Meningitis

  • Review Article
  • Published:
Disease Management and Health Outcomes

Abstract

Meningococcal disease may present as meningitis, septicaemia or a combination of the two. Generally, meningitis has a gradual onset, with fever, headache and neck stiffness as the most frequent clinical symptoms. In contrast, fulminant septicaemia may develop within hours, and is characterised by hypotension, disseminated intravasai coagulation (DIC), petecchial bleedings and shock. Mortality with septicaemia often reaches 30%.

It is of vital importance to diagnose and treat meningococcal disease rapidly. Conventionally, diagnosis is based on culture of the bacterium Neisseria meningitidis from blood or cerebrospinal fluid (CSF) or on microscopy of Gram-negative diplococci in the CSF. Direct bacterial antigen (capsular polysaccharide) detection methods have readily become available. These tests are rapid and do not require the presence of viable bacteria, but their sensitivity and specificity is low. During the last few years, a number of polymerase chain reaction (PCR) tests for the detection of bacterial nucleic acids have been developed. PCR tests are rapid, specific, extremely sensitive, does not require viable bacteria and may allow direct typing of the bacterium.

The drug of choice for treating meningococcal disease is benzylpenicillin. In some rare cases, the sensitivity of N. meningitidis to penicillin is decreased, and ceftriaxone or cefotaxime may be used instead. The severe clinical signs in septicaemia are mainly caused by bacterial endotoxins which are part of the bacterial cell wall and are also released from viable bacteria. Antibiotics do not prevent the effects of endotoxins and supportive therapy to control increased intracranial pressure, hypovolaemia, DIC and shock, are also needed. Following the first case of meningococcal disease in a population, the infection may spread causing one or more secondary cases. The ideal prevention of meningococcal disease is by vaccination. However, no vaccine against group B meningococcal disease exists, and group A and C vaccines have not been implemented in most vaccination programmes. Prevention of the primary case is therefore not achievable, but secondary infection can be prevented by eradication of the disease-causing strain in healthy contacts with chemoprophylaxis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Boslego JW, Tramont EC. Neisseria meningitidis. In: Gorbach SL, Bartlett JG, Blacklow NR, editors. Infectious diseases. 2nd ed. Philadelphia: WB Saunders Company, 1998: 769–75

    Google Scholar 

  2. American Academy of Pediatrics, Meningococcal Infections. In: Peter G, editor. Red book: Report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village (IL): American Academy of Pediatrics, 1997: 357–62

    Google Scholar 

  3. Halstensen A, Pedersen SHJ, Haneberg B, et al. Case fatality of meningococcal disease in Western Norway. Scand J Infect Dis 1987; 19: 35–42

    Article  PubMed  CAS  Google Scholar 

  4. Schwartz M. Acute bacterial meningitis. In: Gorbach SL, Bartlett JG, Blacklow NR, editors. Infectious diseases. 2nd ed. Philadelphia: WB Saunders Company, 1998: 1382–408

    Google Scholar 

  5. Caugant DA, Frøholm LO, Borre K, et al. Intercontinental spread of a genetically distinct complex of clones of Neisseria meningitidis causing epidemic disease. Proc Natl Acad Sci USA 1986; 83: 4927–31

    Article  PubMed  CAS  Google Scholar 

  6. Bjorvatn B, Lund V, Kristiansen BE, et al. Applications of restriction endonuclease fingerprinting of chromosomal DNA of Neisseria meningitidis. J Clin Microbiol 1984; 19: 763–5

    PubMed  CAS  Google Scholar 

  7. Kristiansen BE, Tveten Y, Ask ER, et al. Preventing secondary cases of meningococal disease by identifying and eradicating disease-causing strains in close contacts of patients. Scand J Infect Dis 1992; 24: 165–73

    Article  PubMed  CAS  Google Scholar 

  8. Kristiansen BE, Fermer C, Jenkins A, et al. PCR amplicon restriction endonuclease analysis of the chromosomal dhps gene of Neisseria meningitidis: a method for studying the spread of the disease-causing strain in contacts with patients with meningococcal disease. J Clin Microbiol 1995; 33: 1174–9

    PubMed  CAS  Google Scholar 

  9. Woods CR, Koeuth T, Eastbrook MM, et al. Rapid determination of outbreak-related strains of Neisseria meningitidis by repetitive element-based polymerase chain reaction genotyping. J Infect Dis 1996; 174: 760–7

    Article  PubMed  CAS  Google Scholar 

  10. Infectious diseases kill over 17 million people a year: WHO warns of global crisis [online]. Available from: URL: http://www.who.ch/programmes/whr/1996/pressl.htm [Accessed 1996 Aug 30]

  11. Steering Committee on Meningococcal and Pneumococcal Disease Vaccines. Vaccine and Immunization News. No.1. Geneva: WHO, 1996: June

  12. Moore PS, Reeves MW, Schwartz B, et al. Intercontinental spread of an epidemic group A Neisseria meningitidis strain. Lancet 1989; II: 260–3

    Article  Google Scholar 

  13. Schucat A, Robinson K, Wenger JD. Bacterial meningitis in the United States in 1995. N Engl J Med 1997; 337: 970–6

    Article  Google Scholar 

  14. Flægstad T, Kaaresen PI, Stokland T, et al. Factors associated with fatal outcome in meningococcal disease. Acta Paediatr 1995; 84: 1137–42

    Article  PubMed  Google Scholar 

  15. Benenson AS, editor. Control of communicable disease. 16th ed. Washington, DC: American Public Health Association. 1995: 303–7

    Google Scholar 

  16. Control of meningococcal disease: guidance for consultants in communicable disease control. CDR Review 1995; 5: R196-8

    Google Scholar 

  17. Høiby EA, Bruun J, Andrew M, et al. Guidelines for diagnosis and treatment of systemic meningococcal disease [in Norwegian]. Oslo: National Institute of Public Health, IK-2297, 1989

  18. Gold R. Clinical aspects of meningococcal disease. In: Vedros NA, editor. Evolution of meningococcal disease. Vol IL Boca Raton (FL): CRC Press, 1987: 69–97

    Google Scholar 

  19. Wylie PAL, Stevens D, Drake III W, et al. Epidemiology and clinical management of meningococcal disease in west Gloucestershire: retrospective, population based study. BMJ 1997; 315: 774–9

    Article  PubMed  CAS  Google Scholar 

  20. Nato F, Mazie C, Fournier JM, et al. Production of polyclonal and monoclonal antibodies agaisnt A, B and C capsular poly-saccharides of Neisseria meningitidis and preparation of latex reagents. J Clin Microbiol 1991; 29: 1447–52

    PubMed  CAS  Google Scholar 

  21. Barnes RA, Jenkins P, Coakley WT. Preliminary clinical evaluation of meningococcal disease and bacterial meningitis by ultrasonic enhancement. Arch Dis Child 1998; 78: 58–60

    Article  PubMed  CAS  Google Scholar 

  22. Kristiansen BE, Ask E, Jenkins A, et al. Rapid diagnosis of meningococcal meningitis by polymerase chain reaction. Lancet 1991; 337: 1568–9

    Article  PubMed  CAS  Google Scholar 

  23. Ni H, Knight AI, Palmer WH, et al. PCR in the diagnosis of meningococcal meningitis. Lancet 1992; 340: 1432–4

    Article  PubMed  CAS  Google Scholar 

  24. Newcombe J, Cartwright K, Palmer WH, et al. PCR of peripheral blood for the diagnosis of meningococcal disease. J Clin Microbiol 1996; 34: 1637–40

    PubMed  CAS  Google Scholar 

  25. Borrow R, Claus H, Chaudhry U, et al. siaD PCR ELISA for confirmation and identification of serogroup Y and W135 meningococcal infections. FEMS Microbiol Lett 1998; 159: 209–14

    Article  PubMed  CAS  Google Scholar 

  26. Olcén P, Lantz PG, Backman A, et al. Rapid diagnosis of bacterial meningitis by seminested PCR strategy. Scand J Infect Dis 1995; 27: 537–9

    Article  PubMed  Google Scholar 

  27. Borrow R, Claus H, Guiver M, et al. Non-culture diagnosis and serogroup determination of meningococcal B and C infection by a sialyltransferase (sial) PCR ELISA. Epidemiol Infect 1997; 118: 111–7

    Article  PubMed  CAS  Google Scholar 

  28. Wald ER, Kaplan SI, Mason Jr EO, et al. Dexamethasone therapy for children with bacterial meningitis. Pediatrics 1995; 95: 21–8

    PubMed  CAS  Google Scholar 

  29. Girgis NI, Farid Z, Mikhail IA, et al. Dexamethasone treatment for bacterial meningitis in children and adults. Pediatr Infect Dis J 1989; 8: 848–51

    Article  PubMed  CAS  Google Scholar 

  30. Zahlen A, Nydegger UE, Vaudaux P, et al. Complement-mediated opsonic activity in normal and infected human cerebrospinal fluid: early response during bacterial meningitis. J Infect Dis 1982; 145: 635–46

    Article  Google Scholar 

  31. Tauber MG, Doroshow CA, Hackbarth CJ, et al. Antibacterial activity of beta-lactam antibiotics in experimental meningitis due to Streptococcus pn. eumoniae. J Infect Dis 1984; 149: 568–74

    Article  PubMed  CAS  Google Scholar 

  32. Quagliarello VJ, Scheld WM. Treatment of bacterial meningitis. N Engl J Med 1997; 336: 708–14

    Article  PubMed  CAS  Google Scholar 

  33. Tunkel AR, Scheld WM. Acute bacterial meningitis. Lancet 1995; 346: 1675–80

    Article  PubMed  CAS  Google Scholar 

  34. Cartwright K, Strong J, Gossain S, et al. Early treatment of meningococcal disease. BMJ 1992; 305: 774

    Article  PubMed  CAS  Google Scholar 

  35. Dillon JR, Pauze M, Yeung K-H. Spread of penicillinase-producing and transfer plasmids from the gonococcus to Neisseria meningitidis. Lancet 1983; I: 779–81

    Article  Google Scholar 

  36. Van Esso D, Fontanals D, Uriz S, et al. Neisseria meningitidis strains with decreased susceptibility to penicillin. Pediatr Infect Dis J 1987; 6: 438–9

    Article  PubMed  Google Scholar 

  37. Suez-Nieto JA, Lujan R, Berron S, et al. Epidemiology and molecular basis of penicillin-resistant Neisseria meningitidis in Spain: a 5-year history (1985-1989). Clin Infect Dis 1994; 170: 453–6

    Google Scholar 

  38. Sutcliff EM, Jones DM, el-Sheikh S, et al. Penicillin-insensitive meningococci in the UK. Lancet 1988; I: 657

    Article  Google Scholar 

  39. Jones DM, Sutcliff EM. Meningococci with reduced susceptibility to penicillin. Lancet 1990; 335: 863–4

    Article  PubMed  CAS  Google Scholar 

  40. Jackson LA, Tenover FC, Baker C, et al. Prevalence of Neisseria meningitidis relatively resistant to penicillin in the United States 1991. J Infect Dis 1994; 169: 438–41

    Article  PubMed  CAS  Google Scholar 

  41. Peltola H, Käyhty H, Kuronen T, et al. Meningococcus group A vaccine in children three months to five years of age. Adverse reactions and immunogenicity related to endotoxin content and molecular weight of the polysaccharide. J Pediatr 1978; 92: 818–22

    Article  PubMed  CAS  Google Scholar 

  42. Gold R, Lepow ML, Goldschneider I, et al. Kinetics of antibody production to group A and group C meningococcal polysaccharide vaccines administrated during the first six years of life: prospects for routine immunization of infants and children. J Infect Dis 1979; 140: 690–7

    Article  PubMed  CAS  Google Scholar 

  43. Bjune G, Høiby EA, Grønnesby JK, et al. Effect of outer membrane vesicle vaccine against group B meningococcal disease in Norway. Lancet 1991; 338: 10936

    Article  Google Scholar 

  44. de Moraes JC, Perkins BA, Camargo MCC, et al. Protective efficacy of a serogroup B meningococcal vaccine in Sao Paulo, Brazil. Lancet 1992; 340: 1074–8

    Article  PubMed  Google Scholar 

  45. Perkins BA, Jonsdottir K, Briem H. Immunogenicity of two efficacious outer membrane protein-based serogroup B meningococcal vaccines among young adults in Iceland. J Infect Dis 1998; 177: 683–91

    Article  PubMed  CAS  Google Scholar 

  46. Haneberg B, Dalseg R, Wedege E, et al. Intranasal administration of a meningococcal outer membrane vesicle vaccine induces persistent local mucosal antibodies and serum antibodies with strong bactericidal activity in humans. Infect Immun 1998; 66: 1334–41

    PubMed  CAS  Google Scholar 

  47. Kristiansen BE, Jenkins A. Preventing the spread of meningococcal infection. Dis Manage Health Outcome 1997; 1: 233–40

    Article  Google Scholar 

  48. Olcén P, Kjellander J, Danielsson, et al. Epidemiology of Neisseria meningitidis: prevalence and symptoms from the upper respiratory tract in family members to patients with meningococcal disease. Scand J Infect Dis 1981; 13: 105–9

    PubMed  Google Scholar 

  49. Kristiansen BE, Jenkins A, Tveten Y. Meningococcal disease — who carries the disease-causing strain? BMJ 1998; 317: 621–5

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Telemark Biomedical Centre and University of Tromsø, Tromsø, Norway

    Bjørn-Erik Kristiansen

  2. University Hospital of Tromso, Tromso, Norway

    Trond Flægstad

Authors
  1. Bjørn-Erik Kristiansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Trond Flægstad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bjørn-Erik Kristiansen.

Additional information

About the Authors: Bjørn-Erik Kristiansen is Professor of Medical Microbiology at The University of Tromsø, Norway, and Head of the Department of Medical Microbiology at Telemark Biomedical Centre, Skien, Norway. His main research interest is genetic characterisation of Neisseria meningitidis, and the development of diagnostic and typing methods for this and other species of bacteria.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kristiansen, BE., Flægstad, T. Guidelines for the Diagnosis and Treatment of Meningococcal Meningitis. Dis-Manage-Health-Outcomes 5, 73–81 (1999). https://doi.org/10.2165/00115677-199905020-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-199905020-00002

Keywords

Search

Navigation