Diseases meningococcal meningitis

Meningococcal disease (purulent meningitis) commonly occurs in children, but is also observed in adults. Without antibiotic treatment, the mortality rate is high (85%), and, even with this treatment, cured patients can suffer serious and permanent neurological deficiencies.165 These facts, together with the emergence of antibiotic-resistant strains,8 prompted the rapid development of a commercial vaccine. This vaccine was developed almost simultaneously with the pneumococcal vaccine. 

Pidemics Of Meningococcal Disease. African Meningitis Belt, 2001. Weekly Epidemiological RecordJWorld Health Organization , no. 37 (2001) 282-288. 

It acts by inhibiting RNA synthesis, bacteria being sensitive to this effect at much lower concentrations than mammalian cells it is particularly effective against mycobacteria that lie semidormant within cells. Rifampicin has a wide range of antimicrobial activity. Other uses include leprosy, severe Legionnaires disease (with erythromycin or ciprofloxacin), the chemoprophylaxis of meningococcal meningitis, and severe staphylococcal infection (with flucloxacillin or vancomycin). 

Serogroups A, B, C, W135, and Y are responsible for more than 90% of meningococcal meningitis. The disease affects the early infancy but also occurs in older children and particularly adolescents [8]. In the so-called meningitis belt of Africa, a well-characterized epidemic pattern is observed for group A with some occurrence of group C. 

Examples of chemoprophylaxis in the non-surgical arena include the prevention of endocarditis with amoxicillin in patients with valvular heart disease undergoing dental surgery, and the prevention of secondary cases of meningococcal meningitis with rifampicin among household contacts of an index case. 

Determine whether prophylaxis is indicated for close contacts of patients with CNS infections. Close contacts should be located for patients with suspected meningococcal or Hib meningitis. After consultation with the local health department, antibiotic prophylaxis should be provided promptly to these individuals to avoid secondary disease. 

Rifampin is used in a variety of other clinical situations. An oral dosage of 600 mg twice daily for 2 days can eliminate meningococcal carriage. Rifampin, 20 mg/kg/d for 4 days, is used as prophylaxis in contacts of children with Haemophilus influenzae type b disease. Rifampin combined with a second agent is used to eradicate staphylococcal carriage. Rifampin combination therapy is also indicated for treatment of serious staphylococcal infections such as osteomyelitis and prosthetic valve endocarditis. Rifampin has been recommended also for use in combination with ceftriaxone or vancomycin in treatment of meningitis caused by highly penicillin-resistant strains of pneumococci. 

Other indicalions First-year colle students living in dormitories microbiologists who are routinely exposed to isolates of Neisseria meningitids, military recruits and persons who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic (eg, the "meningitis belt" of sub-Saharan Africa duringthe dry season pecember-June]), particularly... 

Meningococcal vaccine (quadrivalent polysaccharide for serogroups A, C, Y, and W-135)—Consider vaccination for persons with medical indications adults with terminal complement component deficiencies, with anatomic or functional asplenia. Other indications travelers to countries in which disease is hyperendemic or epidemic ("meningitis belt" of sub-Saharan Africa, Mecca, Saudi Arabia for Hajj). Revaccination at 3-5 years may be indicated for persons at high risk for infection (e.g., persons residing in areas in which disease is epidemic). 

Rifampin also is indicated for the prophylaxis of meningococcal disease and Haemophilus influenzae meningitis. To prevent meningococcal disease, adults may be treated with 600 mg twice daily for 2 days or 600 mg once daily for 4 days children should receive 10-15 mg/kg, to a maximum cf600 mg. Combined with a f-lactam antibiotic or vancomycin, rifampin is used in selected cases of staphylococcal endocarditis or osteomyelitis. Rifampin may be used to eradicate nasal staphylococci in patients with chronic furunculosis. 

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