Guidelines for the Early Clinical and Public Health Management of ...

Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease)
Chapter 3: Hospital Management
Key points
• The development of signs suggestive of acute sepsis and/or meningitis is a medical emergency and
mandates prompt intervention.
• Management priorities differ depending on the clinical presentation i.e. that of severe sepsis with or
without associated meningitis, or that of meningitis.
• If a patient has clinical signs or symptoms suggestive of invasive meningococcal disease (meningitis
or septicaemia) they should be given parenteral antibiotics immediately.
• All patients should ideally be placed in isolation in a single room for the first 24 hours of treatment.
• If there are no signs of meningeal irritation or meningitis is not suspected, lumbar puncture is not
required on initial assessment.
• Consider lumbar puncture for a person in whom meningitis is suspected only if there are no
contraindications (the patient is neurologically stable and there are no signs of increased intracranial
pressure or other contraindications).
• Treatment should not be delayed while awaiting results of diagnostic tests.
• Collect blood samples as soon as possible for PCR and culture, and full blood count.
• If petechiae or frank bleeding is evident, formal coagulation studies should be undertaken.
• The patient should be given chemoprophylaxis when able to take oral medication and before
discharge from hospital, unless the disease had already been treated with ceftriaxone.
• The department of public health (medical officer of health) should be notified immediately so that a
public health response can be determined.
• Hospitals and departments of public health should have local protocols for dealing with
chemoprophylaxis including out-of-hours.
3.1 Introduction
The development of signs suggestive of acute sepsis and/or meningitis is a medical emergency and mandates
prompt intervention. Management priorities differ depending on the clinical presentation i.e. that of severe sepsis
with or without associated meningitis, or that of meningitis.
and/or bacterial meningitis is suspected.
In both scenarios it is imperative that appropriate antimicrobials are given as soon as the diagnosis of
sepsis
Acute meningococcal disease, the most common cause of life threatening infection in healthy children and young
adults, commonly presents as severe sepsis and/or meningitis. Rarely, other forms of invasive meningococcal
infection are encountered. The overall mortality rate for meningococcal infection is approximately 3-10%, but can
reach as high as 20-40% in severe sepsis/meningitis. In a review of 407 children in Ireland, with meningococcal
infection who survived to hospital admission between 1995 and 2000, the overall mortality rate was 3.6-4.8%. 19
From 1999 – 2005, the overall case fatality rates for meningococcal infection in Ireland ranged from 3-5% with
somewhat higher rates observed in adults (7-8%). 20
Despite the efficacy of the MenC vaccine, meningococcal infection remains the most common cause of bacterial
meningitis in Ireland. Serogroup B isolates account for the overwhelming majority of cases now diagnosed in
Ireland. The speed with which meningococcal infections are recognized and treated is critical to achieving a
-20-