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VOLUME 1 , ISSUE 3 ( July-September, 2019 ) > List of Articles

REVIEW ARTICLE

Invasive Meningococcal Disease: A Review

Rashna D Hazarika

Keywords : Invasive meningococcal disease, Meningitis, Meningococcemia, Neisseria, Purpura fulminans, Shock

Citation Information : Hazarika RD. Invasive Meningococcal Disease: A Review. Pediatr Inf Dis 2019; 1 (3):95-107.

DOI: 10.5005/jp-journals-10081-1215

License: CC BY-NC 4.0

Published Online: 05-09-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background: Invasive meningococcal disease (IMD) is a potentially fatal disease occurring all over the world. It affects predominantly young children, adolescents and young adults. However, even today cases are missed and there may be a delay in diagnosis and treatment leading not only to a fatal outcome but also to large scale epidemics. Materials and methods: An extensive review of literature was done to describe the history, microbiology, global epidemiology, transmission and risk factors, pathogenesis, clinical features, management, prognosis, care of relatives and close contacts, prevention by the current vaccines available in the world and in India. Results: Invasive meningococcal disease was first described in 1805 in Sweden. Subsequently periodic epidemics continue to occur all over the world. Globally it is present in more than 80 countries. Currently 12 known serotypes are described with a complex microbiology which helps the bacteria to not only survive in the human nasopharynx but also to adhere to and invade the meninges and the blood stream and present as meningitis, meningococcemia or both. Due to its capacity to produce various toxins and ability to survive destruction by the host immune system, it produces a number of clinical manifestations in a short time. Being potentially fatal, death in such patients can occur in a matter of hours. Microbiological diagnosis is difficult as the organism is fastidious and requires special conditions for growth and can explain the poor microbiological results worldwide. However attempts to culture the bacteria should be made from all available sites such as cerebrospinal fluid, blister fluid, blood and even skin biopsy specimen. The cornerstone of management is aggressive treatment with antibiotics, and other supportive care. Complications are common during the course of the infection and one must anticipate and tackle them aggressively and at the appropriate time. A large number of sequelae can occur in spite of optimal management. Prophylactic antibiotics in the care-givers and relatives is extremely important for short term protection. Long term protection of the community as well as of care-givers and close relatives is by vaccination. A number of effective vaccines have been developed over the years for the prevention of this deadly infection. Vaccine cost remains a major hindrance to universal vaccination. Conclusion: Invasive meningococcal disease exists all over the world. It is important to be able to correctly recognize these patients for early and aggressive management. Prevention by vaccination remains the best public health measure to tackle this deadly infection.

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