Review
Meningococcal infections at an army training center

https://doi.org/10.1016/0002-9343(68)90156-3Get rights and content

Abstract

One hundred and twelve cases of bacteriologically proved meningococcal infections over the two and a half year period from December 1963 to June 1966 are reviewed. The spectrum of disease varied from an extremely mild form to an acute fulminating disease leading to death in a matter of hours. Careful observation of all febrile patients with immediate and serial white blood cell counts and repeated inspection for the emergence of petechiae or changes in the sensorium were the essentials of our approach to early diagnosis.

Of sixty-eight meningococci that were serotyped, 92.6 per cent were group B. Of sixty meningococci that were tested for sulfonamide resistance, 21.7 per cent showed partial resistance and 56.6 per cent showed resistance.

Gross mortality in the present series was 7.1 per cent. Hyperglycemia was present initially in 71.8 per cent of the patients tested. Mild azotemia was a common finding early in the course of the disease. Symptoms of acute synovitis were noted in 12.5 per cent. Common electrocardiographic abnormalities were wandering pacemaker and nodal rhythms. The occurrence of shock appeared to be secondary to peripheral vascular failure due to damage of the vasculature from the endotoxinemia; cardiac failure played a role in some patients.

With our present state of knowledge, the approach to patients with meningococcal disease must be early diagnosis, immediate antibiotic treatment and measures to counteract shock, using the more rational modern concepts of volume replacement, peripheral vasodilators and inotropic drugs when indicated.

References (30)

  • H.A. Feldman

    Recent developments in the therapy and control of meningococcal infections

    Dis. Month

    (February 1966)
  • D. Reid

    Meningococcus outbreak at Point Barrow

    Alaska Med.

    (1965)
  • D. Reed et al.

    An epidemic in an Eskimo village due to group B meningococcus. I. Epidemiology

    J.A.M.A.

    (1966)
  • T.H. Corbett et al.

    An epidemic in an Eskimo village due to group B meningococcus. II. Clinical features

    J.A.M.A.

    (1966)
  • H.A. Insaf

    Clinicotherapeutic evaluation of pyogenic meningitis. An analysis of 49 cases

    J. Indian M. A.

    (1964)
  • J.L. Morley et al.

    Meningococcal septicaemia

    West African M. J.

    (1964)
  • W.M. Bristow et al.

    Epidemic meningitis in Naval recruits

    A. J. Pub. Health

    (1965)
  • J.W. Brown et al.

    Meningococcal infections. Fort Ord and California

    California Med.

    (1965)
  • J.R. Gauld et al.

    Epidemiology of meningococcal meningitis at Fort Ord

    Am. J. Epidemiol.

    (1965)
  • W.B. Daniels

    Meningococcal infections

  • E.B. Schoenbach et al.

    The sensitivity of meningococci to sulfadiazine

    Am. J. Hyg.

    (1948)
  • J.W. Millar et al.

    In vivo and in vitro resistance to sulfadiazine in strains of Neisseria meningitidis

    J.A.M.A.

    (1963)
  • T.M. Eickhoff et al.

    Changing susceptibility of meningococci to antimicrobial agents

    New England J. Med.

    (1965)
  • J.M. Leedom et al.

    Importance of sulfadiazine resistance in meningococcal disease in civilians

    New England J. Med.

    (1965)
  • M.H. Lepper et al.

    Meningococcic meningitis. Treatment with large doses of penicillin compared to treatment with Gantrisin

    J. Lab. & Clin. Med.

    (1952)
  • Cited by (52)

    View all citing articles on Scopus

    This material has been reviewed by the Office of The Surgeon General, Department of the Army, and there is no objection to its presentation and/or publication. This review does not imply any indorsement of the opinions advanced or any recommendation of such products as may be named.

    1

    From the Department of Medicine, United States Army Hospital, Fort Polk, Louisiana.

    Present address: Department of Internal Medicine, The Long Island College Hospital, Brooklyn, New York.

    View full text