Suspected Meningococcaemia in a University Dormitory
A 19-year-old male student is brought to the university health centre in Ulaanbaatar during winter. He has had fever for 12 hours and now has a severe headache, vomiting, neck stiffness, and confusion. Temp 39.6°C, HR 132, BP 86/50, RR 28, SpO2 95% on room air. He has a petechial rash on the trunk and legs that does not blanch; the rash began 2 hours ago. He lives in a dormitory with 6 roommates and shares a kitchen. He has no known drug allergies and no recent travel. The health centre has ceftriaxone, crystalloid fluids, oxygen, and PPE, but no ICU. The national referral hospital is 20 minutes away. The nurse must act before the diagnosis is confirmed and also manage exposure risk for staff and students.
1. What infection-control precautions are required, and what is the immediate fluid and antibiotic plan?
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Use droplet precautions plus standard precautions: place him in a single room or cohort, put a surgical mask on him, and have staff wear a mask, gloves, gown, and eye protection. Meningococcus spreads by respiratory droplets, not by airborne route, so an N95 is not required for routine care unless aerosol-generating procedures are performed. Notify the laboratory and public health team immediately.
Immediately assess ABCs, give oxygen if needed, and secure IV access. He is hypotensive and tachycardic, so give a crystalloid bolus of 10-20 mL/kg and reassess; repeat cautiously if shock persists. Take blood cultures if this will not delay treatment, then give ceftriaxone 2 g IV immediately. Do not wait for lumbar puncture or confirmation. Monitor BP, HR, perfusion, urine output, consciousness, and rash progression. Early antibiotics and fluid resuscitation are the interventions that change survival in meningococcaemia.
2. Should a lumbar puncture be done before transfer? Explain the reasoning and the risks.
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No, lumbar puncture should not be done before transfer in this unstable, confused patient. He has hypotension, tachycardia, and confusion, and meningococcaemia can cause raised intracranial pressure and rapid deterioration. LP is deferred when there are signs of raised intracranial pressure, focal neurological deficit, seizures, papilloedema, coagulopathy, or cardiorespiratory instability. The risk is herniation or cardiorespiratory arrest during the procedure, and it would delay antibiotics and transfer.
Blood cultures and meningococcal PCR can be obtained without delaying treatment. Ceftriaxone should be given first. If LP is still needed later, it should be performed after stabilization at the referral hospital, when the benefits outweigh the risks. The nurse should document that LP was deferred for instability and that antibiotics were given before transfer, because this affects later interpretation of cerebrospinal fluid results.
3. What public-health actions are needed for close contacts, and what information should the nurse document?
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Notify the public health authority immediately because meningococcal disease is a notifiable emergency. Identify close contacts: the 6 roommates, anyone sharing the kitchen who had direct contact with oral secretions, and staff or students who performed mouth-to-mouth or unprotected airway care. Arrange chemoprophylaxis within 24 hours, using rifampicin, ciprofloxacin, or ceftriaxone according to national protocol. Advise contacts to seek care urgently if fever, headache, neck stiffness, or rash develops; do not wait for symptoms to give prophylaxis. Vaccination may be considered depending on serogroup and local policy.
Document the time of isolation, PPE used, staff and student contacts, antibiotic time and dose, fluid given, vital signs, and transfer time. Record what advice was given to contacts and who was notified. This supports contact tracing, staff exposure follow-up, and national surveillance.