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MENINGOCOCC
AL
MENINGITIS
(Shi Hong)
Department of Infectious Diseases

Meningococcal meningitis

HIGH
early diagnosis
Morbidity
mortality
Morbidity

modern
therapy
supportive

rate
mortality

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
Immunity bacterial 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
Petechia
infectious
shock
acidosis,
DIC
multiorgans
failure

invade
release

endotoxin

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Pathogenesis
Immunity bacterial 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 type shock 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

abrupt onset

chills

high fever

Headache

Petechias
purpuras
Splenomegaly

Meningitic
Meningitic period
period
intracranial pressure

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

Bacterial culture

spun sediment of CSF

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 severe form in sepsis and
meningoencephalitis

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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likely diagnosis
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Problems

1
2

whats the most likely diagnosis?

what do we still do for definitive

diagnosis?

How to treat this young patient?

To
analyze the case
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Treatment
1

General treatment

Etiological treatment
Antibacterial
activity.
Concentration
in CSF.
Resistance to
drugs
A. Penicillin G
200~400u/kg/da

Other treatment

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

y)

B.Chloromycetin
C.Cephalosporis

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

early
diagnosed
appropriately

treated

poor

poor

Fulminate
meningococcemia

in the
extremes
of age

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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.

Disrupt
Protect

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

Protect
Administer

Protection of the susceptible population

meningococcal vaccines, Chemoprophylaxis

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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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