Meningococcal meningitis: symptoms, what dangers?

There meningococcal meningitis is a infectious disease that can be serious. She is caused by bacteria found in the nasopharynx. Meningococcal meningitis mainly affects babiesyoung children and young people adults. There transmission meningococcal disease occurs during close and repeated contact. “Over the past 10 years the incidence rate was less than 1 case per 100,000 population approximately 500 cases per year. There majority of meningitis is meningococcal B (40 to 50%) and C (20 to 30%). Serogroups W and Y each account for 10-15% of cases. noted Public Health France. “There is a seasonal peak in winter, explains Dr. Belenotti, internist. Meningococcal meningitis represents 25% of total annual meningitis”. What are the symptoms ? What is the risk of contagion? What are the treatments? Is there a vaccine?

Definition: what is meningococcal meningitis?

Meningitis is a infectious disease, potentially serious, due to a bacterium or a virus, which affects the meninges who are the thin coverings of the brain and spinal cord. “In the case of meningococcal meningitis, this is caused by bacteria which is found in 5 to 50% of the population depending on age (asymptomatic carrier) in the nasopharynx, says Dr. Belenotti, internist. It’s a strictly human bacteria who cannot attack animals. There are 12 serotypes of this bacterium, only 6 are known to cause epidemics (AC-W135-Y). It’s a serious pathology, to be taken care of quickly, which can be responsible for serious sequelae and is fatal in half of the cases in the absence of dedicated antibiotic treatment.

Meningococcal B or C meningitis: what are the differences?

“THE meningococcus B predominates in Europe and America and is responsible for sporadic cases, explains the doctor. While C gives real epidemic outbreaks and more readily affects the Americas, Europe, Asia and Sub-Saharan Africa (the “meningitis belt” from Senegal in the west to Ethiopia in the East).”

What are the symptoms of meningococcal meningitis?

The major symptom is a febrile meningeal syndrome Who associates high fever, chills with violent headaches, diffuse, in helmet, intolerance to light (photophobia) and noise (phonophobia) a stiff neck, nausea and vomiting. Meningococcal meningitis is a therapeutic emergency. “Do not hesitate to go to the emergency room or to call a center 15 in the event of headaches associated with a high fever.insists Dr. Belenotti. These first symptoms are sometimes associated with a bacteremia (meningococcemia) or blood circulation of bacteria responsible for septic shock associated with a particularly serious skin complication, purpura fulminans. These are purplish red spots (small haemorrhages) which appear preferentially at the extremities and which are in fact an equivalent of localized necrosis, which extend very quickly. In the event of the presence of purpura fulminans, the mortality under treatment is 20%.

​​​​​​How is meningococcal meningitis transmitted?

The disease is transmitted via rhino-pharyngeal secretions (Flügge droplets), during close contacts (less than 1 meter), repeated and prolonged. As a result, the most favorable conditions are in the family environment or in the community. The period average incubation is 3-4 days but can vary between 2 and 10 days.

Is meningococcal meningitis contagious?

It’s a disease very contagious. “On the other hand, as soon as the patient receives the first dose of antibiotic, the contagion decreases rapidly. The bacterium is fragile and does not survive in the environment” completes the doctor.

Who is most at risk of getting meningococcal meningitis?

According to Public Health France more than 80% of the cases concern patients belonging to the age group 15-24 years10% among the over 65s. “It is a disease which therefore particularly affects the young subject and can interest infants and young children especially those who have not been vaccinated, adds Dr. Belenotti. It is also more likely to interest patients with certain immunity deficiencies: functional asplenia or splenectomypatient having received a hematopoietic stem cell transplant, patient with terminal complement fraction or properdin deficiency.”

It’s a diagnostic and therapeutic urgency. “As soon as the diagnosis is mentioned, urgent care is justified by putting protective measures (mask) in place as soon as possible for the patient and those around him as well as for the medical personnel taking care of the patient, complete the emergency physician. THE diagnosis must be evoked in front of any fever with headache and lead to care at the nearest emergency center, by calling on center 15, in particular in the event that purpura fulminans is observed, indicating circulatory failure and the imminent risk of septic shock. Any home physician suspecting meningococcal meningitis or finding purpura fulminans should administer an antibiotic active on meningococci as soon as possiblecalled ceftriaxone. “For cases of purpura fulminans, the patient is admitted to the emergency room in intensive care to both manage the shock and administer high-dose antibiotics. If the patient is stable, then follow-ups will be performed. blood samples to look for the bacteria (blood culture), an inflammatory syndrome, and a lumbar puncture.”

As soon as the diagnosis is mentioned, urgent treatment is justified.

This examination consists of a sample of the fluid that circulates around the brain and along the spinal cord called cerebrospinal fluid. “When there is a meningitis, this liquid contains the infectious agent responsible and above all inflammatory cells or leukocytes, with a high protein level and a low carbohydrate level compared to blood levels. The presence of the neisseria meningitidis germ signs the diagnosis.” However during purpura fulminans this examination is not necessary before starting any antibiotic therapy. “Similarly, if there are contraindications to lumbar puncture (infection next to the puncture site, coagulation disorder, cardiac or circulatory failure, central neurological signs, disturbances of consciousness, persistent epileptic seizures) the treatment antibiotic will be started.” Sometimes a biopsy with culture of the purpura is performed.

What are the complications of meningococcal meningitis?

The most serious complication is death, which can occur in 20% of cases of treated purpura fulminans. The disease is fatal in approximately 50% of cases if left untreated. “If purpura fulminans extends to the limbs with too much necrotic involvement, amputation of the necrotic parts is sometimes necessary, assures our interlocutor. Meningitis itself can leave a sequela of learning disabilities among the youngest and sensorineural hearing loss in 10-20% of survivors.

What are the treatments for meningococcal meningitis?

The treatment includes hospitalization in the medical service in droplet isolation or in the intensive care unit if necessary. “During severe meningoencephalic damage or purpura fulminans the antibiotic is associated with a corticosteroid that crosses the blood-brain barrier or dexamethasone, says Dr. Belenotti. The antibiotic used is a 3rd generation cephalosporin or ceftriaxone; in case of allergy to penicillins an antibiotic such as ciprofloxacin or rifampicin. Of the intensive care specific are suitable for shock related to meningococcemia.

Which vaccines to prevent meningococcal meningitis?

“About the type C meningococcustwo conjugate vaccines directed against the capsule of meningococcal type C are available: a monovalent vaccine against serogroup C and a tetravalent vaccine directed against serogroups AC W135 and Y”. The current vaccination strategy in France includes a Compulsory vaccination at 5 months followed by recall at 12 months. A catch-up of one dose for all subjects is possible between 2 years and 24 years. “As regards type B meningococcus, there are 2 vaccines directed against bacterial proteins (the capsule is not immunogenic) which have Marketing Authorization in France. They are to be reserved for immunodeficient subjects and in the event of grouped cases or epidemic. It is therefore not mandatory.”

“When a diagnosis of meningococcal meningitis is made, there is an obligation for the doctor and the relevant laboratory to send a mandatory declaration form (cerfa number 12201) by fax to the ARS, concludes the doctor. This will allow to trigger an epidemiological investigation around the diagnosed case”. In fact, prophylactic treatment with antibiotics exists and should be administered to people who have had close and prolonged contact with the sick patient; this concerns the family environment in particular or people who live in a community. Treatment consists of oral antibiotics rifampicin (or in case of allergy ceftriaxone injection) to be taken for 48 hours.

Thanks to Dr. Pauline Belenotti, internist at the Clairval Private Hospital in Marseille.