A 19-year-old college student is brought to the emergency department via ambulance after his roommate found him barely rousable in bed this morning. The patient had developed a fever, headache, and nausea the evening before. On examination, he is stuporous and not responding to questions. The patient is diagnosed with meningococcal meningitis. The roommate received the meningococcal booster vaccine several months ago and has no active symptoms or additional sick contacts. Which of the following is the most appropriate treatment recommendation for the patient's roommate?

Question

A 19-year-old college student is brought to the emergency department via ambulance after his roommate found him barely rousable in bed this morning.  The patient had developed a fever, headache, and nausea the evening before.  On examination, he is stuporous and not responding to questions.  The patient is diagnosed with meningococcal meningitis.  The roommate received the meningococcal booster vaccine several months ago and has no active symptoms or additional sick contacts.  Which of the following is the most appropriate treatment recommendation for the patient's roommate?

Quizplus · Accepted Answer

11ec25c8_d462_e37c_bc81_9d3cbe7bc565_MD0003_00 This patient has Neisseria meningitidis meningitis, a rapidly progressive and potentially fatal infection transmitted via respiratory secretions. N meningitidis has risk of epidemic spread, and most secondary cases develop within 10 days of the initial patient's diagnosis. Risk of transmission occurs from 7 days prior to symptom onset until 24 hours after initiating appropriate antibiotic therapy. Therefore, antimicrobial chemoprophylaxis against N meningitidis should be given to asymptomatic close contacts, regardless of vaccination status, who have had exposure during this period. Close contacts include household contacts and roommates (as in this case), intimate partners, caretakers, and anyone with prolonged (≥8 hours) exposure. Healthcare workers with direct exposure to secretions (eg, during intubation) should also be given prophylaxis. Prophylactic regimens include rifampin, ceftriaxone, or ciprofloxacin (in adults). Antibiotics should be administered as soon as possible after exposure, ideally within a day of diagnosis but up to 2 weeks. (Choice A) Intravenous immunoglobulin is used for postexposure prophylaxis in some conditions (eg, rabies) but does not play a role in prevention of meningococcal meningitis. (Choice C) Adolescents should receive the quadrivalent meningococcal conjugate vaccine at age 11-12 with a booster at age 16. In addition, the meningococcal serogroup B vaccine can be considered for those age 16-18. However, no vaccination confers complete protection, and meningococcal meningitis has a high rate of mortality. Therefore, close contacts of patients with invasive N meningitidis infection should receive chemoprophylaxis, regardless of vaccination status. (Choice D) Asymptomatic nasopharyngeal carriage of N meningitidis can occur, but screening pharyngeal culture is not recommended and does not affect the decision to initiate prophylaxis. Ciprofloxacin is an acceptable chemoprophylactic agent for N meningitidis and should be administered immediately. (Choice E) If symptoms of invasive disease develop, treatment is with a third-generation cephalosporin (eg, ceftriaxone), not rifampin. Educational objective: Antimicrobial chemoprophylaxis against Neisseria meningitidis is indicated for close contacts (regardless of vaccination status) who have had exposure during the 7 days before symptom onset until 24 hours after appropriate antibiotic initiation. Medication regimens include rifampin, ciprofloxacin, or ceftriaxone and should be given as soon as possible. References: Meningococcal prophylaxis (http://www.ncbi.nlm.nih.gov/pubmed/30726023)

A 19-Year-Old College Student Is Brought to the Emergency Department