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MENINGOCOCCAL MENINGITIS
(Shi Hong)

Department of Infectious Diseases

Meningococcal meningitis

HIGH
early diagnosis
Morbidity mortality Morbidity rate mortality modern therapy supportive

measure

low

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A case
Beijing Center for Disease Control and Prevention (CDC) January 11, 2007

The patient was a 14-year-old male student. The onset of this case started quickly with high fever(39C) and headache. Other clinical symptoms included nausea, vomiting, stiff neck and confusion. There was little petechiate rash emerged on the patients four limbs. The Kernigs sign was positive and Brudzinskis sign was negative. The numbers of white cell in the blood and cerebrospinal fluid (CSF) were 3.61010/L and 1.7109/L, respectively.

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Definition
Meningococcal meningitis : Neisseria meningitides Respiratory tract Purulent meningitis
(an acute inflammation of the membranes that cover the brain and spinal cord)

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Etiology

gram-negative coccus Neisseria species 13 serogroups groups A, B, C

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Epidemiology
Sources of infection: carriers and patients

Infectious period : between late incubation period and acute phase, no more than 10 days of onset

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Epidemiology
Routes of transmission Respiratory tract: Close contact:

cough/sneeze

bosoming/kiss/breast-feed

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Epidemiology
Susceptibility Everybody without specific immunity 6 months to 2 years of age. Epidemical features the common season : in the winter and early spring (November to May in next year) The peak incidence is in March to April

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Pathogenesis

Immunitybacterial quantity and virulence

A. bacteria eliminated. B. benign nasopharyngeal carriage or upper respiratory tract infection cured C. temporal meningococemia cured

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Pathogenesis
Immunity bacterial quantity and virulence

<

A. meningococcal septicemia. B. meningococcal meningitis. C. meningococcal arthritis and pericarditis

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Pathogenesis
Immunity<bacterial quantity and virulence A. meningococcal septicemia
endothelial cells
invade
release Petechia infectious shock acidosis, DIC multiorgans failure

endotoxin

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Pathogenesis
Immunitybacterial quantity and virulence B. meningococcal meningitis Neisseria meningitides

the mucosal barrier

the bloodstream the central nervous system increased intracranial pressure convulsion, coma, herniation CSF turbid, sometimes circular obstacle of cerebrospinal fluid and hydrocephalus
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Clinical manifestations

petechia in the skin (Meningococcal meningitis)

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Clinical manifestations Incubation period: generally 2 to 3 days

(Range is 1 to 10 days)

Four types:
Meningococcal meningitis (Moderate type) Fulminate typeshock type, Meningoencephalitic type) 3. Mixed type Meningococcemia- meningitis 4. Mild type (Mild acute meningococcemia)

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Clinical manifestations
Prodromal period

Septic Septicperiod period

an

Meningitic Meningitic period period

intracranial pressure

abrupt onset high fever

chills

Headache

Petechias purpuras

Splenomegaly

headache vomiting restlessness Stiff neck Kernig (+) brudziski (+)

Convalescent period
gradually disappears, recovers to normal.
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Clinical manifestations

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Clinical manifestations

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Laboratory examination Routine laboratory studies of blood:

WBC>20109/L

Polymorphonuclear leukocyte

platelet count(DIC)

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Laboratory examination

Lumbar puncture:

CSF

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Laboratory examination

Cerebrospinal fluid examination

(an important method to establish diagnosis) :

turbid

pressure WBC >100010 /L protein

6

glucose sodium chloride

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Laboratory examination

Bacteriological examination
(an important method to definitive diagnosis) :

Smear: skin lesions

spun sediment of CSF

Bacterial culture
of blood and CSF

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Laboratory examination

Figure : Neisseria meningitidis Gram-stain of a pure culture

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Diagnosis
Epidemic season, age and epidemic situations. Clinical features.
Manifestations of meningoencephalitis severe form in sepsis and

Increased

leukocytes and polymorphonuclear leukocytes predominantly in peripheral blood. Increased intracranial pressure and purulent changes in CSF.

Positive results in bacteriological examination.

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Differential diagnosis

Purulent meningitis caused by other purulent bacteria. Streptococcus pneumonia meningitis, Haemophilus influenzae meningitis, Staphylococcus aureus meningitis. (no overt season,no petechae or purpura) Meningeal tuberculosis. (the history, no petechae or purpura,Bacillus tuberculosis) Sepsis (Shock type) (other causative bacteria in blood cultures)

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A case
Beijing Center for Disease Control and Prevention (CDC) January 11, 2007

The patient was a 14-year-old male student. The onset of this case started quickly with high fever(39C) and headache. Other clinical symptoms included nausea, vomiting, stiff neck and confusion. There was little petechiate rash emerged on the patients four limbs. The Kernigs sign was positive and Brudzinskis sign was negative. The numbers of white cell in the blood and cerebrospinal fluid (CSF) were 3.61010/L and 1.7109/L, respectively.

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Problems

whats the most likely diagnosis?

what do we still do for definitive diagnosis?

How to treat this young patient?

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Treatment
1
General treatment
Isolation hospitalization: Careful monitor nursing. Prevent complication. Maintain the balances of fluid and electrolytes

2
Etiological treatment Antibacterial activity. Concentration in CSF. Resistance to drugs A. Penicillin G 200~400u/kg/day) B.Chloromycetin C.Cephalosporis

3
Other treatment
High fever: anti-pyretic (physical chemical) measures. Increased intracranial pressure: 20 % mannitol (0.5g/kg~2g/kg)

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Treatment
Fulminate type

Shock type Etiology treatment: . Penicillin G Shock should be corrected promptly: a. Volume expanded. b. Metabolic acidosis corrected. c. Vasoactive drugs. d. Adrenal corticosteroids. e. Important organs protected

Meningococcemia-meningitis type Effective antibacterial drugs. Penicillin G. Alleviate cerebral edema Mannitol and 50 per cent Glucose. Adrenal corticosteroids: Dexamethasone Treatment in respiratory failure: lobeline, coramine High fever and seizure: Sedatives: wintermine phenergan
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Prognosis

Good

poor

poor

early diagnosed
appropriately

Fulminate meningococcemia

in the extremes of age

treated

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Prevention
isolate
for 3 days after the symptoms disappeared, generally no less 7 days after the onset

observe

Close contacts: observed medically for 7 days.

To go to theof crowd places should be avoided Protection the susceptible population during the epidemic

Disrupt Protect Protect

Protection of the susceptible population

meningococcal vaccines, Chemoprophylaxis

Administer

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Multiple choice
1. A diagnosis of meningococcal infection
requires the following to be present: a) Headache

b) Neck stiffness c) Photophobia d) vomiting e) Pyrexia

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Multiple choice
2. Meningococci: ( which one is right?)
a) Are most often harmless commensals colonising the nasopharynx b) Are carried by some adolescents who show no signs of disease c) Are transmitted by aerosol d) Are usually transmitted with minimal contact e) Cause infection most frequently in teenagers

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Summarization
Definition
Meningococcal meningitis is an acute purulent meningitis caused by meningococci

Transmission route
occurs through respiratory tract.

The incidence of meningococcal meningitis

The incidence of meningococcal meningitis is the first in purulent meningitis among children.

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Summarization
Clinical characteristics
high fever rapidly; severe headache; vomiting frequently; petechiae and purpura in the skin; meningeal irritations; infectious shock and injuries in brain parenchyma occurred in severe cases and often result in death.

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Summarization
What is meningitis? What is encephalitis?

What causes meningitis and encephalitis?

Who is at risk for encephalitis and meningitis? How are these disorders transmitted?

What are the signs and symptoms?

How are meningitis and encephalitis diagnosed? How are these infections treated?

Can meningitis and encephalitis be prevented?

What is the prognosis for these infections? .

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E-mail: shihongsysu@hotmail.com Qq: 673162735

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Features of meningococcal meningitis in infants

Causes of atypical symptoms are that the crania and fontanelle are not still closed and the central nervous system is not well developed. The features of clinical manifestations Respiratory symptoms always presents with cough. Gastroenteric symptoms Refusal to take food, vomiting and diarrhea are common gastroenteric symptoms. Increased intracranial pressure includes irritability, shrill, seizures and fullness of the fontanelle. Meningeal irritation always is not overt

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Features of menigococcal meningitis in the old

The causes of high incidence in fulminate type In the old the immunity is lower, properdin deficiency and sensitive to endotoxin. Clinical manifestations Symptoms of upper respiratory tract are commonly presented in the old. Mental obtundation is overt. Petechia and purpura are more common. Complications and prognosis usually can be seen with high mortality. Leukocytes Leukopenia is often seen due to lower human body reaction

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