A case of meningococcal meningitis has just been confirmed at a day-care center. The susceptibility of the microorganism is not yet known.
At this point, you should do which one of the following for the day-care center contacts?
Correct Answer E:
Rifampin, in the absence of major contraindications, is the drug of choice for preventing the spread of meningococcal disease when the susceptibility of the organism is not known. In this situation, meningococcal vaccines are of no value because their protective effects take a few days to develop, and because they do not protect against group B meningococci, the most prevalent strain for meningococcal disease. Sulfadiazine is the drug of choice if the meningococcus is known to be susceptible to it. Chloramphenicol and penicillin, which are effective in treating the disease, are ineffective in eliminating nasopharyngeal carriers of meningococci, possibly because they do not appear in high concentrations in saliva. Culturing contacts for meningococcal carriage in the nasopharynx has no value for identifying those at risk for meningococcal disease.
You are a student health director for a community college. An administrator calls regarding recommendations for students exposed to another student with meningococcal meningitis.
The most appropriate action would be to:
Correct Answer B:
The quadrivalent A, C, Y, W-135 meningococcal vaccine does not provide immunity against type B meningococcus, which is responsible for 30% - 50% of cases of invasive meningococcal disease. Therefore, antibiotic prophylaxis with rifampin, ciprofloxacin, or ceftriaxone is indicated for all exposed persons.
A 14-year-old male presents to your office with a high fever that began suddenly. He has a diffuse petechial rash and some nuchal rigidity on examination. A lumbar puncture is performed, and gram-negative diplococci are found. You admit him to the hospital.
Which one of the following would be most appropriate at this time?
Correct Answer C:
Meningococcal disease remains a leading cause of sepsis and meningitis. Those in close contact with patients who have presumptive meningococcal disease are at heightened risk. While secondary cases have been reported, they are rare because of prompt chemoprophylaxis of household members and anyone directly exposed to the index patient’s oral secretions. There is no need to isolate family members. The risk for secondary disease among closest contacts is highest during the first few days after the onset of illness in the index patient, mandating immediate chemoprophylaxis of those exposed. The delay in immunity post vaccination makes it necessary to use other preventive measures instead.
One day after a nurse performs CPR on an emergency-department patient, she learns that the patient had meningococcal meningitis.
Which one of the following is the most appropriate chemoprophylaxis for this condition?
Health-care workers exposed to a patient with meningococcal meningitis are at increased risk of developing systemic disease and should receive chemoprophylaxis, especially if the contact is intimate. Secondary cases usually occur within 4 days of the initial case. Therefore, prophylactic treatment should begin as soon as possible. Rifampin has been shown to be 90% effective in eliminating meningococcus from the nasopharynx. Other appropriate chemoprophylactic agents include minocycline and ciprofloxacin.
Even high doses of penicillin may not eradicate nasopharyngeal meningococci. Prednisone has no place in chemoprophylaxis. Meningococcal vaccine appears to have clinical efficacy, but it usually takes more than 5 days to become effective.
The use of automated external defibrillators by lay persons in out-of-hospital settings:
The use of automated external defibrillators (AEDs) by lay person, trained and otherwise, has been quite successful, with up to 40% of those treated recovering full neurologic and functional capacity. Good Samaritan laws have been passed covering the use of AEDs by well-intentioned lay persons. There are initiatives for widespread placement of AEDs, to include commercial airlines and other public facilities. Implantable cardioverter defibrillators (ICDs) are useful in known at-risk patients, but the use of AEDs is for the population at large.
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