Meningococcal Meningitis Management

Patient Care and Infection Prevention

Patients with suspected meningococcal meningitis should receive fluid resuscitation for hypotension, with an initial bolus of 500 ml crystalloid, while implementing appropriate PPE, and should be considered for ICU admission if they have septic shock or deteriorating neurological status 1
Appropriate antibiotic therapy should be initiated promptly, considering the patient's condition and potential for septic shock, and patients should be managed with droplet precautions, including wearing a surgical mask, gown, and gloves, until they have received 24 hours of effective antibiotic therapy 1

Healthcare workers should wear surgical masks when in close contact with the patient, and standard infection prevention precautions should be implemented alongside droplet precautions, with N95 respirators reserved for aerosol-generating procedures or suspected COVID-19 co-infection 1
Patients with suspected or confirmed Neisseria meningitidis infection require droplet precautions, not airborne isolation, and should be placed in a single room or maintain >3 feet spatial separation from other patients, with healthcare workers wearing surgical masks when in close contact (<3 feet) with the patient 1, 2

Blood for hemoculture (aerobic and anaerobic) should be collected as soon as possible, within 1 hour of hospital arrival, and CSF should be collected when it is safe to perform a lumbar puncture, with samples from any identifiable lesion, lung, spleen, and intestinal content also collected before any antibiotic therapy 1, 3, 4
Respiratory samples, including nasopharyngeal swabs, should be collected to isolate Neisseria meningitidis, which can be identified in up to 50% of patients, even when blood and CSF cultures are negative due to prior antibiotic use, and samples should be sent for direct bacterial culture, including antibiotic resistance studies, and molecular analyses and viral cultures should be performed for respiratory samples, if necessary 3, 1, 4

Antibiotic prophylaxis is only required for healthcare workers who have had close contact with a patient's respiratory secretions, primarily those involved in airway management without wearing a mask, with options including Rifampin, Ciprofloxacin, and Ceftriaxone, and should be limited to healthcare workers with direct exposure to respiratory secretions, not all staff caring for the patient 1, 5
Patients must complete 24 hours of effective antibiotic therapy before discontinuing droplet precautions, as stated by the UK Joint Specialist Societies guideline, which also recommends droplet precautions as sufficient for N. meningitidis, with transmission occurring through respiratory droplets rather than through airborne routes 1, 2, 5