Review Question - QID 106431

This patient has bacterial meningitis caused by Neisseria meningitidis, a Gram-negative diplococci. Family members and close contacts should be treated with prophylactic rifampin.

Chemoprophylaxis is indicated in patients who have had close contact with a person with confirmed meningococcal infection, such as a daycare worker caring for a child with meningococcal meningitis or family in the same household. Healthcare workers do not need chemoprophylaxis unless they have had direct exposure to respiratory secretions. Rifampin is the preferred agent, but ciprofloxacin can be used in those who cannot tolerate rifampin, such as those on warfarin or other medications impacted by the CYP450 pathway.

Kimmel reports that close contacts of patients with invasive meningococcal disease should receive antimicrobial chemoprophylaxis, regardless of whether the disease is sporadic or occurs in an outbreak setting. Household contacts have a 500 to 800 times greater rate of disease and should be given prophylaxis, ideally within 24 hours after identification of the index patient.

Woodard and Berman describe Neisseria meningitidis as the most common cause of meningitis in people aged 2-18 with a mortality rate ranging from 4-40% and substantial morbidity in 11-19% of survivors. They report serogroups B and C to be the most common causes in the United States, with serogroup C causing most disease among adolescents, a population at risk for invasive meningococcal disease.

Image A shows the Gram-negative diplococci characteristic of Neisseria meningitidis.

Incorrect Answers:
Answer 1: Observation alone is not appropriate given the family's exposure to someone with active infection.
Answers 2-3: Asymptomatic close contacts do not need to be treated with IV agents.
Answer 4: Ampicillin and cefotaxime are agents typically used to treat neonatal meningitis, and have no role in chemoprophylaxis for close contacts of a patient with N. meningitidis meningitis.