Describe complications and management of acute meningococcal meningitis.

Complications of Acute Meningococcal Meningitis

Acute meningococcal meningitis can lead to a wide range of complications, categorized as neurological, systemic, and sequelae. The severity and type of complications depend on the causative serogroup, the patient’s age, and the promptness of treatment.

Neurological Complications

• Cerebral Edema: Increased intracranial pressure due to swelling of the brain, leading to herniation and potentially fatal outcomes.
• Seizures: Occur in approximately 20-30% of cases, often focal or generalized tonic-clonic.
• Cranial Nerve Palsies: Particularly affecting cranial nerves III, VI, and VII, resulting in diplopia, facial weakness, and other neurological deficits.
• Hydrocephalus: Obstruction of cerebrospinal fluid (CSF) flow, leading to increased intracranial pressure.
• Cerebral Infarction: Reduced blood flow to areas of the brain, causing localized damage.
• Hearing Loss: Can be sensorineural, often permanent, affecting one or both ears.

Systemic Complications

• Septic Shock: A life-threatening condition characterized by hypotension, organ dysfunction, and disseminated intravascular coagulation (DIC).
• Disseminated Intravascular Coagulation (DIC): Abnormal activation of the coagulation cascade, leading to widespread microthrombi and bleeding.
• Acute Respiratory Distress Syndrome (ARDS): Severe lung injury causing pulmonary edema and respiratory failure.
• Myocarditis: Inflammation of the heart muscle, potentially leading to heart failure.
• Adrenal Insufficiency: Damage to the adrenal glands, resulting in cortisol deficiency.

Sequelae (Long-Term Complications)

• Cognitive Impairment: Difficulty with memory, attention, and executive function.
• Neurological Deficits: Persistent weakness, paralysis, or sensory loss.
• Behavioral Problems: Irritability, anxiety, and depression.
• Amputations: Due to severe tissue necrosis resulting from DIC and septic shock.

Management of Acute Meningococcal Meningitis

Management focuses on early diagnosis, prompt antibiotic therapy, and supportive care to minimize complications.

Initial Assessment and Diagnosis

• Lumbar Puncture (LP): Essential for CSF analysis (cell count, protein, glucose, Gram stain, culture).
• Blood Cultures: To identify the causative organism and guide antibiotic selection.
• Imaging (CT Scan/MRI): Considered before LP if there are signs of increased intracranial pressure (papilledema, altered mental status, focal neurological deficits).

Antibiotic Therapy

Empiric antibiotic therapy should be initiated immediately after obtaining blood cultures and ideally before LP. The choice of antibiotic depends on local resistance patterns.

Antibiotic	Dosage (Adults)	Notes
Ceftriaxone	2g IV q12h	First-line treatment in many regions.
Penicillin G	4 million units IV q4h	Used if the organism is penicillin-sensitive.
Vancomycin	1-2g IV q12h	Added if penicillin resistance is suspected.

Supportive Care

• Fluid Management: Maintain adequate hydration, but avoid overhydration to prevent cerebral edema.
• Corticosteroids: Dexamethasone (0.15 mg/kg IV q6h for 2-4 days) may reduce the risk of hearing loss and neurological sequelae, particularly in patients with *Streptococcus pneumoniae* meningitis, but its benefit in meningococcal meningitis is debated.
• Management of Increased Intracranial Pressure: Elevate the head of the bed, consider mannitol or hypertonic saline.
• Seizure Control: Benzodiazepines or other anticonvulsants.
• Respiratory Support: Oxygen therapy, mechanical ventilation if needed.
• Vasopressors: For management of septic shock.

Chemoprophylaxis

Close contacts of patients with meningococcal meningitis should receive chemoprophylaxis with rifampin, ciprofloxacin, or ceftriaxone to prevent secondary cases.