High risk and low incidence diseases: Meningococcal disease

Meningococcal disease is a serious condition that carries with it a high rate of morbidity and mortality.

This review highlights the pearls and pitfalls of meningococcal disease, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

Invasive meningococcal disease is a severe, rapidly progressive infection caused by Neisseria meningitidis associated with high morbidity and mortality. Emergency physicians must maintain a high index of suspicion, as early symptoms may mimic a benign viral illness, potentially delaying treatment with serious consequences. This early phase is typically followed by the emergence of more specific features of meningococcal infection, such as meningococcal meningitis, meningococcemia, or a combination of both. Suspected cases warrant immediate implementation of droplet precautions and strict isolation to reduce the risk of healthcare worker exposure and secondary transmission. Prompt treatment, ideally within one hour of clinical suspicion, is essential. Management includes empiric parenteral antibiotics, and in cases of suspected meningitis, adjunctive corticosteroids should be administered prior to or concurrently with the first antibiotic dose. Patients with meningococcemia and shock require aggressive fluid resuscitation, vasopressor support as indicated, and prompt admission to a critical care setting. All close contacts of confirmed cases should receive chemoprophylaxis, regardless of their meningococcal immunization status.

An understanding of meningococcal disease can assist emergency clinicians in diagnosing and managing this potentially deadly disease.