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Neisseria meningitidis, also simply known as meningococcus is a gram-negative bacterium best known for its role in meningitis.
Clinical Presentations
Meningitis is the most well publicised condition. Whilst a non-specific illness initially, this can rapidly progress through fever, headache and neck stiffness to coma & death. The mortality is approximate 10% of cases. Suspicion of meningitis is a medical emergency and immediate medical assessment sought.
Septicaemia was previously unmentioned by the media, resulting in a number of infant deaths. Whilst there may be an absence of the classical meningitis symptoms, the presence of a non-blanchable purpuric rash is easly ignored by those not aware of its significance. Septicaemia carries an approximate 50% mortality rate over a few hours from inital onset. Anyone developing a rash that does not turn white if pressed with a glass should be immediate admitted to a hospital casualty department.
UK policy is that any General Practitioner doctor seeing a suspected case of meningococcus meningitis or septicaemia should give intravenous antibiotics whilst hospital admission is sought. The possible reduction in subsequent microbiological confirmation of infection, due starting treatment before testing, is offset by the reduced mortality.
Note: not all cases of a pupura rash are due to septicaemia, but the other causes also need prompt investigation (eg ITP).
Strains
There are many strains of meningococcus, clinically the most important are A, B, C and W135:
A - occurs most often in sub-sahara Africa and Vaccination is recomended prior to travel with the 'Men A&C' vaccine.
B - is the most lethal form, comprising 40% of UK cases. There is no vaccination currently available for this strain.
C - caused approxiamately 60% of UK cases before the introduction of successful vaccination programme for infants. Previously the unconguted 'C' component of 'Men A&C' was ineffective in those under 2years. The development of a conjugated form (Men C conj) was needed to provoke immunity infants.
W135 - is particularly a problem for those undergoing annual pilgramage to Mecca. It is a requirement of Saudi Arabia that all those intending to go on Hajj have a certificate of Men W135 vaccination.
Those with impaired immunity may be at particular risk of meningococcus, eg those with nephrotic syndrome or splenectomy. See asplenia for vaccination protocols.
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