Meningococcemia natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Ammu Susheela, M.D. [3]

Overview

Neisseria meningitidis bacteria can cause meningitis to fatal septicemia. The symptoms of meningitis appear within 3-7 days of exposure and presents with fever and signs of bacterial meningitis. If it causes septicemia, it can be very fatal where the patient dies in few hours. In non fatal conditions they develop disabilities like arthritis, gangrene, disseminated intravascular coagulopathy and cutaneous vasculitis. The outcome is uncertain in septicemic patients but prognosis is good in non septicemic patients with early intervention and treatment.

A common outcome of meningococcal infection is meningitis. When caused by Neisseria meningitidis bacteria it is known as meningococcal meningitis. When someone has meningococcal meningitis, the protective membranes covering their brain and spinal cord, known as the meninges, become infected and swell.
The symptoms of meningococcal meningitis can appear quickly or over several days. Typically they develop within 3-7 days after exposure.
In newborns and infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to notice. The infant may appear to be slow or inactive, irritable, vomiting or feeding poorly. In young children, doctors may also look at the child’s reflexes, which can also be a sign of meningitis.
In adults the symptoms are mainly fever, headache, stiff neck, nausea, vomiting, photophobia and altered mental status.
Meningococcal meningitis is very serious and can be fatal. In fatal cases, deaths can occur in as little as a few hours. In non-fatal cases, permanent disabilities can include hearing loss and brain damage.

Blood stream infection of Neisseria meningitidis bacteria can cause either either septicemia or bacteremia.
The bacteria enter the bloodstream and multiply, damaging the walls of the blood vessels and causing bleeding into the skin and organs.
Clinical manifestations include fatigue, vomiting, cold hands and feet, chills, severe aches, pain in the muscles, joints, chest or abdomen, rapid breathing and diarrhea.
In the later stages patients develop a dark purple rash.
Meningococcal septicemia is very serious and can be fatal.
In fatal cases, death can occur within few hours.
In non-fatal cases, permanent disabilities can include amputation of toes, fingers, or limbs or severe scarring as a result of skin grafts.

Patients who do not develop meningitis also tend to have a poorer outcome.

Arthritis
Disseminated intravascular coagulopathy (DIC)
Gangrene due to lack of blood supply, that may lead to limb amputation.
Inflammation of blood vessels in the skin (cutaneous vasculitis).
Myocarditis
Pericarditis
Shock
Severe damage to adrenal glands that can lead to low blood pressure (Waterhouse-Friderichsen syndrome).

10%-15% of cases are fatal. Of patients who recover 11%-19% have permanent hearing loss, mental retardation, loss of limbs, or other serious sequelae.

Early treatment results in a good outcome. When shock develops, the outcome is less certain.
Individuals with the following conditions may have a life threatening outcome: