[ender18d]

So as you think of your treatment and epidemic management plans for Trapper John, here are some of the clinical pearls about neisseria meningitidis infection:

n. meningitidis should scare the heck out of you if you are a health care provider. Many times, this is the patient who just seems to have some sort of a cold, but RAPIDLY progresses to much more severe illness and death if not treated. Patients may go from initial presentation to death in hours. This is also a fairly contagious infectious agent, spread by close contact.

There are three basic manifestations of meningococcal infection:
-Meningitis (patient 2)
-Meningitis with accompanying meningococcemia (patient 3)
-Meningococcemia without clinical evidence of meningitis (patient 1... although the faint headache may point to the start of meningitis)

The three classic signs of meningitis are:
-Fever
-Altered Mental Status
-Nuchal Rigidity

Meningococcal meningitis adds a fourth "classic" sign which is often the first sign of serious illness in these patients:
-Non-blanching petichiae/purpura

Additional worrisome signs may include mottling of skin, leg pain, and cold hands/feet.

You may not get all of these signs/symptoms in all patients!

The clinical standard for treatment is to begin ABX therapy within 30min of considering the diagnosis.

And for those of you who are thinking: "but aren't soldiers immunized for this?" The current vaccine covers n. meningitidis types A, C, Y, and W-135. Type B accounts for 25% of infections, and only VERY recently has a vaccine become available (google "princeton meningitis vaccine" for the story) .

I'll let Trapper John take it from here!