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Meningococcal Infections

By Larry M. Bush, MD, Affiliate Professor of Clinical Biomedical Sciences; Affiliate Associate Professor of Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University; University of Miami-Miller School of Medicine

Meningococcal infections are caused by Neisseria meningitidis (meningococci) and include meningitis and bloodstream infections.

  • Infection is spread by direct contact with nasal and throat secretions.

  • People feel generally ill and have other, often serious symptoms, depending on the area infected.

  • Identifying the bacteria in a sample taken from infected tissue confirms the diagnosis.

  • Antibiotics and fluids must be given intravenously as soon as possible.

More than 90% of meningococcal infections are

  • Meningitis: Infection of the tissues covering the brain and spinal cord (meninges)

  • Sepsis: Infection of the bloodstream

Infections of the lungs, joints, and heart are less common.

In temperate climates, most meningococcal infections occur during winter and spring. Local outbreaks can occur, most often in sub-Saharan Africa between Senegal and Ethiopia. This area is known as the meningitis belt.

Meningococci reside in the throat and nose of some people without causing symptoms. Such people are called carriers. People often become carriers after outbreaks. Infection usually occurs in people who have been exposed to meningococci rather than in carriers. Infection is spread by direct contact with nasal and throat secretions.

Most commonly infected are

  • Children aged 6 months to 3 years

Infections are also common among

  • Adolescents

  • Military recruits

  • College freshmen living in dormitories

  • People with certain immune system disorders

  • Microbiologists working with meningococci

Outbreaks account for only a small percentage of cases and tend to occur among people who spend time or live in close quarters with others.


Most people feel very ill.

Meningitis can cause fever, headache, red rash, and a stiff neck and, in infants, feeding problems, a weak cry, and sluggishness.

Bloodstream infections may cause a rash of red or purple spots. A severe infection may cause dangerously low blood pressure (shock), a tendency to bleed, and dysfunction (failure) of many organs (such as the kidneys and liver).

Overall, 10 to 15% of people who are treated die of meningococcal infections. More than half of people with severe bloodstream infections die. Of people who recover, 10 to 20% have serious complications, such as permanent hearing loss, intellectual disability, or loss of fingers or toes.

Rarely, infection develops more slowly and causes more gradual, mild symptoms.


  • Examination and culture of samples of blood or other infected tissues, including cerebrospinal fluid obtained by spinal tap

Doctors suspect meningococcal infection in people who have typical symptoms, particularly if symptoms occur during an outbreak.

To confirm the diagnosis, they take samples of blood or other infected tissues or do a spinal tap (lumbar puncture) to obtain a sample of the fluid that surrounds the brain and spinal cord (cerebrospinal fluid). The samples are examined under a microscope to check for and identify bacteria. The samples are also sent to a laboratory, where the bacteria can be grown (cultured) and identified.

Sometimes doctors do blood tests that detect antibodies to the bacteria, but the results have to be confirmed by culture.

The bacteria may also be tested to determine which antibiotics are effective (a process called susceptibility testing).


A meningococcal vaccine is available in the United States.

Routine vaccination is given to

  • All children aged 11 to 12 yr, with a booster at age 16

Vaccination is also recommended for the following:

  • People living in an area affected by an epidemic (to control the epidemic)

  • Military recruits

  • College students who live in dormitories or who are freshmen

  • Travelers to areas where these infections are common, such as sub-Saharan Africa during the dry season from December to June and Saudi Arabia to attend the Hajj

  • People who work with meningococci in laboratories or industry

  • People who are aged 2 months and older and have an immune system disorder, particularly those whose spleen has been removed or damaged (as can occur in people with sickle cell disease)

After exposure to meningitis

Family members, medical personnel, and other people in close contact with people who have a meningococcal infection should be given an antibiotic by mouth (such as a few doses of rifampin or one dose of ciprofloxacin or levofloxacin) or by injection (such as one dose of ceftriaxone) to prevent infection from developing.

During an outbreak, meningococcal vaccine is also given (in addition to antibiotics) to people in close contact with a person who has a meningococcal infection.


  • Antibiotics given intravenously

  • Fluids given intravenously

  • Possibly corticosteroids

People are usually admitted to an intensive care unit and given antibiotics and fluids intravenously as soon as possible, before doctors get the culture results identifying the organism causing the infection. If meningococci are confirmed, doctors change the antibiotics to those that are most effective against the bacteria, typically ceftriaxone or penicillin, given intravenously.

Corticosteroids (such as dexamethasone) may be given to children and adults who have meningitis. These drugs help prevent brain damage.

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