This document discusses Meningococcal disease, which is caused by the bacterium Neisseria meningitidis. It can cause meningitis (infection of the brain lining) or meningococcal septicemia (blood infection). The disease is transmitted through respiratory secretions. Specimens should be collected from patients for diagnosis. Morphologically, N. meningitidis appears as gram-negative oval or spherical diplococci. It grows on blood and chocolate agar. Antibiotic prophylaxis should be given within 24 hours to exposed individuals. Recommended antibiotics include rifampin, ciprofloxacin, or ceftriaxone. Health care workers caring for patients must take precautions

1. Meningococci
Dr. Abhijeet Mane
Department of Microbiology
BVDUMC
Pune

2. Introduction
• Meningococcal disease is an infection caused
by bacterium Neisseria meningitidis
• Transmission to staff
– most likely within 24 hours of admission
– Prior to antibiotic / chemoprophylaxis
• Diseases caused:
– Meningitis (infection of brain lining)
– Meningococcal septicemia (infection of blood

3. Contd.
• Hostel students, army barracks
• Specimens to be collected from patient
– CSF culture / serology / Gram stain
– Throat swab culture
– Blood culture
– Conjunctival swab culture / stain
– Nasal swab culture
– Skin lesion culture

4. Morphology
• Gram negative, oval or spherical diplococci,
0.6-0.8µm in size, adjacent sides flattened.
• In smears from lesions, generally intracellular
• Non motile, capsulated

5. Cultural characteristics
• Aerobic, 5-10% CO2 , 35-36 degree Celsius
• Blood agar, Chocolate agar, MH starch casein
hydrolysate agar commonly used
• Modified Thayer Martin useful selective
medium
• Catalase and oxidase positive

6. Pathogenicity
• Strict human parasites inhabiting nasopharynx
• Meningitis:
– Cocci spread from nasopharynx to meninges
– Travel along olfactory nerve
– Invariably found in CSF
• Meningococcemia:
– Acute fever, chills, malaise, prostration
– Petechial rash occurs early in disease
– Eyes, ears, lungs, adrenals may occur
– Waterhouse Friderichsen syndrome – shock, DIC,
multisystem failure

8. Exposure
• Exposure transmission may occur after
intensive, direct contact.
• Patients’ respiratory secretions contaminate
oral / nasal mucous membranes of staff
• Facial protection (mask, eyeglasses) for close
contacts (<1 meter)

9. Exposure (contd.)
• Which procedures:
– Mouth to mouth
– ET intubation
– Fundoscopy (eye examination)
– Close proximity (>30 mins)
– Patient having seizures
– Laboratory staff handling samples

10. What is your job as administrator?
• Isolate such a patient
• To provide direction to hospital for prevention
of acquisition of infection to health care
workers
• To identify and administer prophylaxis after
risk assessment

11. Antibiotic chemoprophylaxis
• Should be given ASAP (within 24 hours)
• Prophylactic drugs include:
– Rifampin
– Ciprofloxacin
– Ceftriaxone

12. Antibiotic chemoprophylaxis (contd.)
Recommended
chemoprophylaxis
Dose Duration Cautions
Rifampin
<1 month age
>1 month age
5mg/kg oral/12 hrs
10mg/kg oral/12 hrs
2 days
2 days Not recommended
for use during
pregnancy,
alcoholism, etc.
Ceftriaxone
<15 years
>15 years
125mg i.m.
250 mg i.m.
Single dose
Single dose
Ciprofloxacin
>18 years
(preferred for women
on OC pill)
500 mg oral Single dose
Not recommended
for use during
pregnancy and <12
years of age kids

13. Procedure for institution of
prophylaxis
• Report from Microbiology department to HICC
• All personnel to use mask, gloves and aprons
• Special care during ET intubation / suctioning
• Use eye wear if splash anticipated
• Keep a list of all personnel who attended the
patient
• Observe them
• Infection control designated doctor to review
records of exposure risk and administer
prophylaxis

14. Preplacement
• No need for preplacement screening for
N.meningitidis
• Vaccine not routinely recommended for HCW
• Only for those handling laboratory personnel
handling live meningococcal cultures
• They should receive quadrivalent A, C, Y, W-135
conjugate vaccine
• No. of doses: 1
• Duration of protection: 3-5 years or more

15. Thank you …