Review Question - QID 202687

The gram stain shows gram negative diplococci, suggestive of Neisseria meningitidis. Antibiotic prophylaxis is indicated for meningococcal meningitis for those who have had close contact for 8 hours or those who have had direct exposure to respiratory secretions; the patient’s boyfriend meets both criteria and should be treated.

Meningitis is a potentially life-threatening condition and requires accurate diagnosis and treatment of the patient and contacts. In adults, the most common bacterial etiologies of meningitis are S. pneumoniae and N. meningitidis. Meningococcal meningitis patients typically present with fever, headache, neck stiffness, photophobia, altered mental status, and occasionally a petechial rash. Workup includes lumbar puncture with Gram stain, culture, and evaluation of susceptibilities.

Bamberger discusses the diagnosis, management, and prevention of meningitis. He discusses antibiotic prophylaxis after meningicoccus exposure and recommends rifampin, ciprofloxacin, or ceftriaxone to all those in close contact with meningococcal patients for at least 8 hours or those in contact with oral secretions.

Chaudhuri et al. present guidelines for management of bacterial meningitis. They state that infection of close contacts occurs at a rate of 2-4/1000 and recommend that asymptomatic contacts should still receive antibiotic prophylaxis.

Figure A is a gram stain showing gram negative diplococci, consistent with Neisseria meningitidis.

Incorrect answers:
Answer 2-4: These individuals have not been exposed to direct respiratory secretions and do not require prophylaxis.
Answer 5: Identification of at-risk asymptomatic patients is crucial for meningococcal meningitis.