Meningococcal disease is a serious illness in children caused by meningococcal bacterial (Neisseria meningitides) infection. The disease can have various spectrums and can present as septicemia or meningitis or both. Although incidence of illness is less common but severity makes it a significant health issue as chances of mortality and morbidity is quite high.
About 50 % individual caries meningococcal bacteria in their nose but chances of spread of infection to blood depends on genetic predisposition, individual immunity, environmental factor and virulence of bacteria. As disease progression is quite rapid (within days), early diagnosis and treatment is not possible often and children land in emergency in serious condition. Chances of death due to septicemia is quite high (8-13%) and those who survive can have 10 % incidence of deafness and poor neurodevelopmental outcome each.
Disease incidence is more common in children below 4 years and again incidence peaks during adolescence and after 65 years of age in unimmunized individuals. Infection rate is high in crowded places like hostels, barracks etc. and in hot and humid environment. It can lead to an epidemic outbreak. Meningococcal meningitis is the third most common cause of meningitis in children after pneumococcal and H. influenza bacteria.
Symptoms and sign:
Children are presented with fever, headache, lethargy, irritability, vomiting, non-blanching (purpura) rash. These illnesses are often confused with viral illness but rapid progressive course of disease makes the child very sick within few days. They develop classical sign of septicemia with cold calmly limbs, fast breathing, decreased urine output, poor sensorium etc. children with meningitis can have neck rigidity also.
Diagnosis and treatment:
Disease can be diagnosed by clinical presentation with high index of suspicion and laboratory investigation like CBC, CRP, gram stain & blood C/S, spinal fluid examination etc. These children need immediate attention and may require pediatric ICU for management of shock with IV fluid, antibiotics, oxygen, inotropes etc. under strict vital monitoring.
Disease can be prevented by immunization. Conjugated meningococcal vaccine available in market can be administered in 2 doses at 9 and 12 months. Those who missed vaccination early can be immunized with single dose after 2 years of age.