MENINGOCOCCEMIA

Meningococcemia is an acute and potentially life-threatening infection of the bloodstream.

CAUSES
Meningococcemia is caused by Neisseria meningitidis, an encapsulated gram-negative diplococcus as depicted in the image below. Acquisition of N meningitidis can result in asymptomatic pharyngeal colonization or invasive disease. The bacteria frequently lives in a person's upper respiratory tract without causing visible signs of illness. The bacteria can be spread from person to person through respiratory droplets. Family members and those closely exposed to someone with the condition are at increased risk. The infection occurs more frequently in winter and early spring.

MODE OF TRANSMISSION
Direct contact with respiratory droplets from nose and throat of infected persons. Carrier may exist without cases of meningitis. Transmission through inanimate objects.

INCUBATION PERIOD
2-10 days with an average of 3-4 days.

SIGNS AND SYMPTOMS

High grade fever Weakness Joint and muscle pain Hemorrhagic rash Progressing from few petechiae to widespread purpura and ecchymoses Meningeal irritation like headache Nausea and vomiting Stiff neck Bulging fontanel (among infants) Seizure or convulsion Sensorial changes Hemorrhagic Rash Purpura Ecchymoses Complications

Raised intra-cranial pressure. Disseminated intravascular coagulation Seizures Circulatory collapse Organ failure Deafness Blindness Lasting neurological deficits Reduced IQ Gangrene leading to amputations Disseminated Intravascular Coagulation Gangrene

DIAGNOSTIC EXAMINATIONS
(1) Blood culture

Is a microbiological culture of blood. It is employed to detect infections that are spreading through the bloodstream Lumbar puncture (2) Complete Blood Count (3) Lumbar puncture to obtain spinal fluid sample for CSF culture Fetal position A spinal needle is inserted between the lumbar vertebraeL3/L4 or L4/L5 (4) Skin biopsy and gram stain A skin biopsy is a procedure in which a sample of skin tissue is removed, processed, and examined under a microscope. (5) Urinalysis A urinalysis (or "UA") is an array of tests performed on urine and one of the most common methods of medical diagnosis.

TREATMENT
Antibiotics -Penicillin G -Ceftriaxone (Rocephin) -Cefotaxime (Claforan) -Trimethoprim / Sulfamethoxazole o (Bactrim, Septra)

METHODS OF PREVENTION AND CONTROL

Respiratory isolation of patients for 24 hours. Hospital personnel are required to wear mask, gloves, goggles and gown especially when doing endo-tracheal incubation. Chemoprophylaxis The public should be educated to avoid overcrowded places.

 Only those with intimate exposure to naso-pharyngeal secretion or unprotected exposure during endo-tracheal incubation warrants chemophrophylaxis.

TREATMENT
Treatment in primary care usually involves prompt intramuscular administration of benzylpenicillin and then an urgent transfer to hospital for further care. Once in hospital, the antibiotics of choice are usually IV broad spectrum 3rd generation cephalosporins, e.g.cefotaxime or ceftriaxone. Benzylpenicillin and chloramphenicol are also effective. Supportive measures include IV fluids, oxygen, inotropic support, e.g. dopamine or dobutamine and management of raised intracranial pressure. Steroid therapy may help in some adult patients, but is unlikely to affect long term outcomes.

NURSING CARE
The patient must be given chemoprophylaxis before discharge to assure the elimination of meningococcus in the naso-pharyx. Observe infection control measures like proper washing of hands with soap and water and other respiratory isolation especially for the first 24 hours upon admission. Practice the gown technique including masks, goggles and gloves especially when doing endo-tracheal incubation. Bear in mind other isolation technique like non-sharing of utensils, cups, lipstick, cigarettes and other water bottles, dishes and glasses. Dont use also musical instruments, mouth guards or anything else that has been in the mouth of the infected person. Advice the importance of check-up after one week discharge, then monthly for those with complication (neurologic deficit) till improved and contact tracing.