A nurse is concerned about exposure to a patient with possible meningitis because they assisted with the patient's lumbar puncture in the ED and did not wear a mask. The CSF Gram stain shows gram-positive cocci in pairs and chains. Does the nurse need to receive post-exposure prophylaxis (PEP)?

• A. Yes
• B. No
• C. Only if fever develops
• D. Only if exposure to other patients

Answer: (B)

Post-exposure prophylaxis for meningitis is determined by the causative organism. Prophylaxis is clearly indicated for close contacts of meningococcal disease (Neisseria meningitidis) and, in some settings, for Haemophilus influenzae type b, but not for pneumococcal meningitis. The Gram stain description of gram-positive cocci in pairs and chains is most consistent with Streptococcus pneumoniae, the pneumococcus. While pneumococcal meningitis is serious and requires prompt treatment for the patient, there isn’t a proven prophylaxis strategy to protect healthcare workers after exposure to pneumococcus. The standard approach is to monitor and treat if symptoms develop, and focus on appropriate infection control and vaccination to prevent future cases. If the organism had been meningococcus, however, close contacts would need post-exposure prophylaxis with an appropriate antibiotic.