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Neisseria meningitidis (meningococcus)

Classification: - 5 pathogenic serogroups (A, B, C, Y, W135) - bacteria from serogroup A cause meningitis in sub-Saharan Africa - those from serogroup B cause disease in N. America & Europe - serotype B is the most lethal form Etiology: risk factors - HIV1 infection confers 10-fold risk of invasive meningococcus [10] - complement deficiency (C5,C6,C7,C8 deficiency) [12] - hypogammaglobulinemia - systemic lupus erythematosus - functional hyposplenia & asplenia [12] Epidemiology: - infects only humans, no animal reservoir - nasopharyngeal carriage is a precursor to disease; however, the majority of carriers do not develop disease - outbreaks on 2 college campuses in 2013 caused by serotype B (meningococcal vaccine not effective against serotype B) - 2nd most common cause of bacterial meningitis in adults (after Streptococcus pneumoniae) [12] - 2 cases of meningococcal disease caused by serotype B were diagnosed at a Rhode Island college in 2015 where the carriage rate for noncausative strains was 25% [13] - outbreak of serogroup C among men who have sex with men, Southern California 2016 [14] - Neisseria meningitidis serogroup W accounted for 42% of cases in Georgia 2014-2016 [15] - serogroup W isolates emerged rapidly in Europe & Australia over the past few years - ciprofloxacin-resistant, beta-lactamase-producing serogroup Y Isolates detected in the United States 2019-2020 [16] Pathology: - etiologic agent of meningitis, mortality ~10% - septicemia, mortality ~50% bacterial lipopolysaccharide induces release of inflammatory cytokines via interactions with neutrophils, macrophages & endothelium Clinical manifestations: 1) see meningitis - fever, headache, nuchal rigidity, coma, death 2) see sepsis - purpuric rash, non blanching, petechiae Laboratory: - lumbar puncture for CSF analysis - complete blood count - WBC count may be elevated (17,000/mm3, 91% neutrophils)* - thrombocytopenia may be noted (90,000/mm3) [12] - plasma D-dimer may be elevated [12] - Neisseria meningitidis antigen - Neisseria meningitidis serotype - Neisseria meningitidis serology - Neisseria meningitidis DNA - Neisseria meningitidis serotype DNA panel - Neisseria meningitidis rRNA - Neisseria meningitidis in CSF - CH50 assay is recurrent Neisseria infections or family history of disseminated Neisseria infection [17] * example from case report [12] Complications: - permanent neurologic sequellae diabetes insipidus, coma ... - loss of limbs from excessive vasopressors needed to sustain blood pressure during septic shock - Waterhouse-Friderichsen syndrome - disseminated intravascular coagulation - nosocomial pneumonia - pericarditis during convalescence - death Management: 1) supportive therapy, especially for septic shock 2) antibiotic therapy a) penicillin G 300,000 units/kg/day up to 24 miilion units/day, administered IV every 4 hours - do NOT administer intrathecally - resistance 1st appeared in 1988 b) chloramphenical 100 mg/kg/day IV up to 4 g/day, resistance is emerging c) cefotaxime, ceftriaxone, ceftizoxime & ceftazidime may be useful for penicillin-resistance 3) glucocorticoid therapy is controversial 4) prophylactic antibiotics for close contact: a) household members, close friends b) start as soon as possible, preferably within 24 hours c) 1-3% of household contacts will develop disease without prophylaxis - 500-800 fold risk over general population d) adults - rifampin 600 mg PO BID for 2 days, or - ciprofloxacin* 500 mg PO once, or - ceftriazone 250 mg IM 5) vaccines - Mennactra ages 11-55 - Menommune for others, travelers - no effective vaccine for serogroup B * ciprofloxacin-resistance emerging, cases in Minnesota & North Dakota reported (case were serotype B) [7] * ciprofloxacin provided for prophylaxis at Rhode Island college in 2015 [13]

Related

meningiococcemia (purpura fulminans) meningitis meningococcal polysaccharide vaccine (Menomune-A/C/Y/W-135, MenACWY-CRM, Menactra, MenACYW-D) meningococcal serogroup B vaccine (Bexsero, Trumenba, 4CMenB)

General

Neisseria

Properties

KINGDOM: monera DIVISION: SCHIZOMYCETES

References

  1. Tettelin et al. Science 287:1809-15, 2000 (genome sequence of serogroup B strain MC58)
  2. Nassif. Science 287:1767-8, 2000
  3. Prescriber's Letter 8(7):37 2001
  4. Journal Watch 24(15):122, 2004 Purcell B, Samuelsson S, Hahne SJ, Ehrhard I, Heuberger S, Camaroni I, Charlett A, Stuart JM. Effectiveness of antibiotics in preventing meningococcal disease after a case: systematic review. BMJ. 2004 Jun 5;328(7452):1339. Review. PMID: 15178612 http://bmj.bmjjournals.com/cgi/content/full/328/7452/1339
  5. Bilukha OO, Rosenstein N; National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC). Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2005 May 27;54(RR-7):1-21. PMID: 15917737 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm
  6. Prevention and control of meningococcal disease: recommendations for use of meningococcal vaccines in pediatric patients. American Academy of Pediatrics (AAP) http://www.aap.org/advocacy/releases/mengpolicyfinal.pdf
  7. Centers for Disease Control and Prevention (CDC). Emergence of fluoroquinolone-resistant Neisseria meningitidis - Minnesota and North Dakota, 2007-2008 MMWR Morb Mortal Wkly Rep 2008, 57:173 PMID: 18288075
  8. Wikipedia, Neisseria meningitidis http://en.wikipedia.org.wiki/Neisseria_meningitidis
  9. Cohn AC et al Prevention and Control of Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. March 22, 2013 / 62(RR02);1-22 http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6202a1.htm
  10. Miller L et al Elevated Risk for Invasive Meningococcal Disease Among Persons With HIV. Ann Intern Med. Published online 29 October 2013 PMID: 24166695 http://annals.org/article.aspx?articleid=1763213
  11. CDC HEALTH ADVISORY. November 27, 2013 Notice to Healthcare Providers: Recognizing and Reporting Serogroup B Meningococcal Disease Associated with Outbreaks at Princeton University and the University of California at Santa Barbara. http://emergency.cdc.gov/HAN/han00357.asp
  12. Manian FA, Alame D Case records of the Massachusetts General Hospital. Case 11-2015. A 28-year-old woman with headache, fever, and a rash. N Engl J Med. 2015 Apr 9;372(15):1454-62 PMID: 25853750 http://www.nejm.org/doi/full/10.1056/NEJMcpc1415165
  13. Soeters HM et al. Serogroup B meningococcal disease outbreak and carriage evaluation at a college - Rhode Island, 2015. MMWR Morb Mortal Wkly Rep 2015 Jun 12; 64:606 PMID: 26068563
  14. Nanduri S, Foo C, Ngo V, et al. Outbreak of Serogroup C Meningococcal Disease Primarily Affecting Men Who Have Sex with Men - Southern California, 2016. MMWR Morb Mortal Wkly Rep. ePub: 2 September 2016 http://www.cdc.gov/mmwr/volumes/65/wr/mm6535e1.htm
  15. Moore AE, MacNeil JR, Wang X, et al. Emergence of Localized Serogroup W Meningococcal Disease in the United States - Georgia, 2006-2016. MMWR Morb Mortal Wkly Rep 2018;67:894-897 https://www.cdc.gov/mmwr/volumes/67/wr/mm6732a5.htm
  16. Centers for Disease Control & Prevention (CDC) Health Advisory. June 18, 2020 Detection of Ciprofloxacin-resistant, beta-lactamase-producing Neisseria meningitidis Serogroup Y Isolates, United States, 2019-2020. https://emergency.cdc.gov/han/2020/han00433.asp - McNamara LA, Potts C, Blain AE, et al. Detection of Ciprofloxacin-Resistant beta-Lactamase-Producing Neisseria meningitidis Serogroup Y Isolates, United States, 2019-2020. MMWR Morb Mortal Wkly Rep 2020;69:735-739 PMID: 32555137 Free PMC article https://www.cdc.gov/mmwr/volumes/69/wr/mm6924a2.htm
  17. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021