Meningococcal Infection
Meningococcal infection is a rare but serious bacterial disease that can turn deadly within hours. Early recognition and rapid treatment can save lives, yet many people mistake its early symptoms for a common cold or flu.
Table of contents
- What is meningococcal infection?
- Types of meningococcal disease
- What causes this disease and how does it spread?
- Who is at higher risk?
- Signs and symptoms
- Serious complications
- How is it diagnosed?
- Treatment options
- Prevention and vaccination
What is meningococcal infection?
Meningococcal infection is a serious illness caused by bacteria called Neisseria meningitidis, also known as meningococcus. This infection can affect different parts of the body and lead to life-threatening conditions[1][2].
The bacteria can infect the meninges, which are the three thin layers of tissue that cover the brain and spinal cord, similar to protective wrapping around these vital organs. The bacteria can also enter the bloodstream and damage blood vessel walls[1][2].
Although meningococcal infection is rare, with around 400 to 500 cases reported annually in the United States, it remains a medical emergency that requires immediate attention. In 2024, 503 cases were reported, the highest number since 2013[1][10].
Meningococcal disease, Neisseria meningitidis infection
Types of meningococcal disease
The two most common types of meningococcal infections are meningococcal meningitis and meningococcal septicemia (also called meningococcemia)[2][3].
With meningococcal meningitis, the bacteria infect the lining around the brain and spinal cord, causing dangerous swelling. This inflammation can lead to severe headaches, stiff neck, and confusion[2][9].
Meningococcal septicemia occurs when the bacteria enter the blood and damage the walls of blood vessels. This causes bleeding in the skin and organs, which can appear as a distinctive rash on the body[2][3].
Less commonly, meningococcal bacteria can cause other types of infections, including pneumonia (lung infection), septic arthritis (infected joint), or infections of the heart[5].
What causes this disease and how does it spread?
Meningococcal infection is caused by Neisseria meningitidis bacteria. Interestingly, about 1 in 10 people carry these bacteria in the back of their nose and throat without getting sick. Sometimes, however, the bacteria can move from the throat to other parts of the body and cause serious infection[2][8].
The disease spreads from person to person through respiratory and throat secretions, such as saliva or spit. This typically happens through close contact activities like kissing, coughing, sneezing, or sharing drinks and eating utensils. People living together in close quarters, such as college dormitories or military barracks, are more likely to pass the bacteria to each other[1][2][3].
The good news is that these bacteria are not as contagious as germs that cause the common cold or flu. The bacteria do not live long outside the human body and cannot survive on surfaces, so you are not likely to get infected by touching something a sick person has touched[1][2].
Who is at higher risk?
Anyone can get meningococcal disease, but certain groups of people face a higher risk[2][3].
Infants younger than 1 year old are at increased risk because their immune systems are still developing. Teenagers and young adults, particularly those between ages 16 and 23, are another high-risk group. First-year college students living in dormitories and military recruits are especially vulnerable because germs can pass quickly in crowded living spaces[3][10].
People with certain medical conditions also face greater risk. These include individuals with a damaged spleen or no spleen, those with sickle cell disease, people living with HIV, and those with immune system disorders. People taking certain medications called complement inhibitors, such as eculizumab (Soliris®) or ravulizumab (Ultomiris®), are also at higher risk[1][3].
Other risk factors include traveling to areas where meningococcal disease is common, such as the “meningitis belt” in sub-Saharan Africa, exposure to tobacco smoke, and working with meningococcal bacteria in laboratories[1][3][10].
Signs and symptoms
Meningococcal disease symptoms can appear suddenly and progress very quickly. They typically develop 3 to 4 days after a person is infected, but can appear anywhere from 2 to 10 days after exposure[3][7].
Common symptoms include sudden high fever, severe headache, stiff neck, nausea and vomiting, sensitivity to bright light, confusion or irritability, extreme tiredness, and loss of appetite. Many of these symptoms are similar to the flu, which can make diagnosis difficult[1][2][3].
One distinctive sign of meningococcal disease is a skin rash that looks like dark, discolored pinpoints or larger areas that resemble bruises. This rash does not turn pale when you press on it with a finger or the side of a clear drinking glass. The rash can be a late sign of the disease and indicates a medical emergency[1][5][10].
Other possible symptoms include difficulty walking or staying upright, joint and muscle pain, diarrhea, cold hands and feet, rapid breathing, and seizures[1][3].
Symptoms in babies and young children can be different and harder to recognize. Babies may be irritable for no reason, refuse to eat, appear very tired or floppy, have a high-pitched or moaning cry, or have a bulging soft spot on the top of their head[1][3].
Because the disease can become deadly in as little as 24 to 48 hours, it is critical to seek medical help immediately if you or someone you know experiences these symptoms[9][10].
Serious complications
Meningococcal disease is extremely serious. Even with proper treatment using antibiotics, about 10 to 15 out of every 100 people who get the disease will die[1][2][3].
Among survivors, about 1 in 5 people will have long-term disabilities and serious health problems. These permanent complications can include brain damage, kidney damage, loss of limbs (arms, legs, fingers, or toes), nerve damage, and total hearing loss (deafness)[1][2][3][10].
Some people may also experience seizures, learning difficulties, and other nervous system problems that affect their quality of life long after recovery from the initial infection[3].
How is it diagnosed?
Diagnosing meningococcal disease can be challenging for healthcare providers because the early symptoms are often similar to common illnesses like a cold or flu[1][2].
If a healthcare provider suspects meningococcal disease, they will recommend several tests. These typically include blood tests and a procedure called a spinal tap (also called lumbar puncture), where a sample of fluid is collected from around the spine[1][2].
The samples are sent to a laboratory to look for bacteria. Laboratory workers try to grow (culture) the bacteria from the samples. If Neisseria meningitidis bacteria grow, this confirms the diagnosis. Other tests can sometimes detect and identify the bacteria even if cultures do not show growth[2].
Healthcare providers may also perform imaging tests, such as CT scans or MRI scans, to check for swelling or other problems with the brain[1].
Because meningococcal disease can progress so rapidly, treatment with antibiotics typically begins immediately when the disease is suspected, even before test results confirm the diagnosis[2][12].
Treatment options
Meningococcal disease is always viewed as a medical emergency. People with suspected or confirmed meningococcal disease need to be admitted to a hospital for treatment[2][3].
Healthcare providers treat meningococcal disease with antibiotics. Prompt treatment with antibiotics is essential to reduce the risk of death and serious complications. The sooner treatment begins, the better the chances of recovery[1][2][3].
The recommended antibiotics include extended-spectrum cephalosporins, such as ceftriaxone or cefotaxime. Once laboratory results identify the specific bacteria and confirm which antibiotics will work best, treatment may be adjusted. A typical treatment course lasts 7 days[12][13].
Depending on how serious the infection is, people with meningococcal disease may need additional treatments beyond antibiotics. These can include breathing support, medications to maintain blood pressure, fluids given directly into a vein to prevent dehydration, oxygen through a face mask if there are breathing difficulties, and steroid medication to help reduce swelling around the brain[1][10][15].
In severe cases, surgery may be needed to remove dead tissue, and special wound care may be required for skin damage[10].
People may need to stay in the hospital for several days, and in some cases treatment may continue for several weeks. Even after going home, it may take time to feel completely back to normal[1].
Additional treatment to eliminate the bacteria from the nose and throat may be needed. If ceftriaxone or cefotaxime are not used for treatment, patients should receive antibiotics like rifampin or ciprofloxacin before hospital discharge to clear the bacteria and prevent spreading it to others[12].
Prevention and vaccination
The best way to prevent meningococcal disease is through vaccination. Vaccines offer the most effective protection against this serious infection[2][3][10].
Several types of meningococcal vaccines are available that protect against different strains of the bacteria. There are five major types (called serogroups A, B, C, W, and Y) of Neisseria meningitidis bacteria that cause most disease around the world[3][7].
Meningococcal conjugate vaccine (MenACWY) protects against four strains. This vaccine is recommended for all preteens at age 11-12 years, with a booster dose at age 16 years. If the first dose is given at or after age 16, a booster is not needed[7][10].
Meningococcal B vaccine (MenB) protects against the B strain. This vaccine is recommended for people 10 years and older who are at increased risk. Teens and young adults age 16-23 years may also choose to get this vaccine for short-term protection, with the preferred age being 16-18 years[7][10].
A combination vaccine (MenABCWY) is also available as an option for people age 10 years and older who need protection against both MenACWY and MenB at the same visit[7][10].
Vaccines are also recommended for children and adults at increased risk for meningococcal disease due to certain medical conditions, travel to areas where the disease is common, laboratory workers who handle meningococcal bacteria, military recruits, and people exposed during an outbreak[2][3][10].
Close contacts of someone with meningococcal disease should receive antibiotics to prevent them from getting sick. A healthcare provider or health department generally decides who should receive these preventive antibiotics[2][3].
Other prevention measures include avoiding sharing drinks, eating utensils, cigarettes, or anything else that goes into the mouth with others[7].
