It is fatal in one in two cases, without antibiotic treatment.
Meningococcal meningitis is an infectious disease that can be fatal, it represents 25% of the total annual meningers. According to Public Health France, more than 80% of cases concern patients aged 15 to 24, 10% among those over 65. “It is a disease that particularly affects the young subject and can interest infants and young children especially those who have not made vaccinationexplains Dr. Belenotti, internist doctor. It also more readily interests patients with certain deficit in immunity: functional asplénia or splenectomy, patient who received a hematopoietic stem cell transplant, patient with a deficit in terminal fraction of the complement or in properdine. There is a seasonal peak in winter. “
Definition: What is meningococcal meningitis?
Meningococcal meningitis is due to a bacteria that affects the meninges, the fine envelopes of the brain and the spinal cord. “The bacteria is found in 5 to 50% of the population depending on the age (asymptomatic carrier) in the rhinopharynx, Specifies Dr. Belenotti. It is a strictly human bacteria that cannot attack animals. There are 12 serotypes of this bacteria, only 6 are known to give epidemics (AC-W135-Y). It is a serious pathology, to be taken care of quickly, which can be responsible for heavy sequel and is fatal in half of the cases in the absence of dedicated antibiotic treatment. ”
Meningococcal meningitis B or C: what differences?
“Meningococcus B predominates in Europe and America and is responsible for sporadic cases, details the doctor. While the C gives real epidemic puffs and more readily affects the Americas, Europe, Asia and sub-Saharan Africa (“Senegal meningitis belt in the west to Ethiopia East).”
What are the symptoms of meningococcal meningitis?
The major symptom is a feverish meningeal syndrome which combines a high fever, chills with violent headache, 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 15 center in the event of ills of associates with a high fever”
“Do not hesitate to go to the emergency room or call a 15 center in the event of ills of associated with a high feverinsists Dr. Belenotti. With these first symptoms, there is sometimes a bacteremia (meningococcemia) or a blood circulation of bacteria responsible for a septic shock associated with a skin complication of a particular gravity, the purpura fulminans. These are purplish red spots (small hemorrhages) which appear preferentially at the ends and which are in fact an equivalent of localized necrosis, which extend very quickly. If a purpura fulminans, mortality under treatment is 20%”.
How is meningococcal meningitis transmitted?
The disease is transmitted via the 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 surroundings or in community. The average incubation period is 3-4 days but can vary between 2 and 10 days.
Is meningococcal meningitis contagious?
It is a very contagious disease. “On the other hand, as soon as the patient receives the first dose of antibiotic contagion decreases quickly. The bacteria is fragile and does not survive in the environment” Complete the doctor.
It is a diagnostic and therapeutic emergency. “As soon as the diagnosis is mentioned, urgent care is justified by putting protective gestures (mask) to the patient and those around them as soon as the medical staff supporting the patient, Complete the emergencyist. The diagnosis must be mentioned in front of any fever with headache and lead to care in the closest emergency center, using the center 15, especially in the event that a purpura fulminans is noted signing circulatory failure and the imminent risk of shock septic.” Any home doctor suspecting meningococcal meningitis or noting a purpura fulminans must administer an active antibiotic as soon as meningococcal, called ceftriaxone. “For cases of purpura fulminans, the patient is admitted to emergency emergencies to both take care of the shock and administer antibiotics in high doses. If the patient is stable will then be made blood samples in search of the bacteria (Hémoculture), an inflammatory syndrome, and a lumbar puncture. ”
As soon as the diagnosis is mentioned, urgent management is justified
This examination consists of a liquid sample circulating around the brain and along the spinal cord called cerebro-spinal liquid. “When there is meningitis, this liquid contains the responsible infectious agent and especially cells of inflammation or leukocytes, with a high protection rate and a low carbohydrate level compared to blood rates. The presence of the germ Neisseria Meningitidis signs the diagnosis. ” However during purpura fulminans this examination is not necessary before starting any antibiotic therapy. “In the same way if there are contraindications to the lumbar puncture (infection compared to the puncture point, coagulation disorder heart failure or circulatory, central neurological signs, consciousness disorders, persistent epilepsy crises) treatment antibiotic will be started. ” Sometimes a biopsy with Purpura cultivation is carried out.
What are the complications of meningococcal meningitis?
The most serious complication is the death which can occur in 20% of the cases of Purpura Fulminans treated. The disease is fatal in around 50% of cases in the absence of treatment. “”If the purpura fulminans extends to the limbs with too much necrotic involvement, an amputation of the necrotic parts is sometimes necessary, ensures our interlocutor. Meningitis in itself can leave as a consequence learning disabilities in the youngest and a deafness of perception in 10 to 20 % of survivors. ”
What are the treatments for meningococcal meningitis?
Treatment has hospitalization. “During serious meningoencephalic or purpura Fulminans, antibiotic is associated with a corticosteroid that passes the hemato meningeal barrier or dexamethasone, Specifies Dr. Belenotti. The antibiotic used is a 3rd generation or ceftriaxone cephalosporin; In case of penicillin allergy an antibiotic of the ciprofloxacin or rifampicin type. Specific resuscitation care is suitable for shock related to meningococcemie.
What vaccines to prevent meningococcal meningitis?
Since January 1, 2025, the vaccination of all infants against meningococcus B has been compulsory (and compulsory to enter community: crèches, schools …). In replacement of vaccination against meningococcus C, ACWY tetravalent vaccination has also been compulsory in all infants since January 1, 2025. In adolescents aged 11 to 14, ACWY vaccination is recommended, whatever their previous vaccination.
“When a diagnosis of meningococcal meningitis is made there is an obligation for the doctor and the laboratory in order to send as soon as possible a compulsory declaration print (cerfa number 12201) by fax to the ARS, concludes the doctor. This will make it possible to trigger an epidemiological survey around the diagnosed case “. Indeed a prophylactic treatment by antibiotic exists and is to be administered in people who have had close and prolonged contact with the sick patient; This concerns the family entourage in particular or the people who live in community. Treatment consists of oral antibiotics rifampicin (or in case of an injection ceftriaxone allergy) to be taken for 48 hours.
Thank you to Dr Pauline Belenotti, internist doctor at the Private Clairval Hospital in Marseille.
