Review Question - QID 102747

This patient spent a significant amount of time caring for an individual with known bacterial meningitis. He was likely exposed to respiratory droplets in the process, and as a result requires chemoprophylaxis for prevention of meningococcal infection.

Neisseria meningitidis is a common cause of bacterial meningitis in young patients, and has the potential to be spread to others via respiratory droplets. Chemoprophylaxis is indicated in patients who have had close contact with affected patients, such as a parent caring for a child with meningococcal meningitis. Healthcare workers do not need chemoprophylaxis unless they have had direct exposure to respiratory secretions (e.g. performing suctioning of oral secretions, endotracheal intubation). Rifampin is a commonly utilized prophylactic agent to prevent development of meningococcal infection. Ceftriaxone and ciprofloxacin are also sometimes used. However, recent data suggests emergence of fluoroquinolone resistance in some strains of Neisseria meningitidis.

Siddiqui et. al review meningococcal disease. They discuss the clinical manifestations and diagnosis of meningococcal meningitis, as well as indications for chemoprophylaxis in close contacts of affected patients. They recommend the use of rifampin as a first line chemoprophylactic agent.

Illustration A depicts the characteristic symptoms of bacterial meningitis.

Incorrect Answers:
Answer 1: Doxycycline may be used for Lyme disease prophylaxis after tick bites in Lyme-endemic regions. However, it is not recommended for chemoprophylaxis against Neisseria meningitidis.

Answer 2: Levofloxacin is not not recommended as chemoprophylaxis against Neisseria meningitidis. Ciprofloxacin, another fluoroquinolone antibiotic, is sometimes used.

Answer 3 Meropenem is not recommended for chemoprophylaxis against Neisseria meningitidis.

Answer 4: Penicillin is sometimes utilized for infection prophylaxis in asplenic children. However, it is not recommended for chemoprophylaxis against Neisseria meningitidis.

Bullet Summary:
Close contacts exposed to the respiratory droplets of patients with meningococcal meningitis require chemoprophylaxis with rifampin for prevention of acquired meningococcal infection.