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LOGO MENINGOCOCCAL MENINGITIS (Shi Hong) Department of Infectious Diseases Meningococcal meningitis HIGH ● early diagnosis Morbidity mortality Morbidity ● modern therapy ● supportive rate mortality measure low Meningococcal meningitisLOGO www.themegallery.com 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(39°C) and headache. ◆ Other clinical symptoms included nausea, vomiting, stiff neck and confusion. ◆ There was little petechiate rash emerged on the patient’s four limbs. ◆ The Kernig’s sign was positive and Brudzinski’s sign was negative. ◆ The numbers of white cell in the blood and cerebrospinal fluid (CSF) were 3.6×1010/L and 1.7×109/L, respectively. www.themegallery.com LOGO What was the most likely diagnosis Definition Meningococcal meningitis : ★ Neisseria meningitides ★ Respiratory tract ★ Purulent meningitis (an acute inflammation of the membranes that cover the brain and spinal cord) Meningococcal meningitisLOGO www.themegallery.com Etiology ◆ ◆ ◆ ◆ gram-negative coccus Neisseria species 13 serogroups groups A, B, C What causes Meningococcal meningitis www.themegallery.com LOGO Epidemiology Sources of infection: carriers and patients Infectious period : between late incubation period and acute phase, no more than 10 days of onset Meningococcal meningitisLOGO www.themegallery.com Epidemiology Routes of transmission ⑴ Respiratory tract: ⑵ Close contact: cough/sneeze bosoming/kiss/breast-feed Meningococcal meningitisLOGO www.themegallery.com 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 www.themegallery.com LOGO Who is at risk? Pathogenesis Immunity>bacterial quantity and virulence A. bacteria eliminated. B. benign nasopharyngeal carriage or upper respiratory tract infection →→cured C. temporal meningococemia →→cured Meningococcal meningitisLOGO www.themegallery.com Pathogenesis < Immunity bacterial quantity and virulence A. meningococcal septicemia. B. meningococcal meningitis. C. meningococcal arthritis and pericarditis Meningococcal meningitisLOGO www.themegallery.com Pathogenesis Immunity<bacterial quantity and virulence A. meningococcal septicemia endothelial cells invade release endotoxin Petechia ▼infectious shock ▼acidosis, ▼DIC ▼multiorgans failure ▼ Meningococcal meningitisLOGO www.themegallery.com 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 Meningococcal meningitisLOGO www.themegallery.com Clinical manifestations petechia in the skin (Meningococcal meningitis) What are the signs and symptoms www.themegallery.com LOGO Clinical manifestations Incubation period: generally 2 to 3 days (Range is 1 to 10 days) Four types: ⒈ Meningococcal meningitis (Moderate type) ⒉ Fulminate type(shock type, Meningoencephalitic type) 3. Mixed type (Meningococcemia- meningitis) 4. Mild type (Mild acute meningococcemia) What are the www.themegallery.com signs and symptoms LOGO 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. Meningococcal meningitisLOGO www.themegallery.com Clinical manifestations Meningococcal meningitisLOGO www.themegallery.com Clinical manifestations Meningococcal meningitisLOGO www.themegallery.com Laboratory examination ⒈ Routine laboratory studies of blood: WBC>20×109/L Polymorphonuclear leukocyte platelet count(DIC) Meningococcal meningitisLOGO www.themegallery.com Laboratory examination Lumbar puncture: CSF Meningococcal meningitisLOGO www.themegallery.com Laboratory examination ⒉ Cerebrospinal fluid examination (an important method to establish diagnosis) : turbid ● pressure ● WBC >1000×10 /L ● protein 6 ● glucose ● sodium chloride Meningococcal meningitisLOGO www.themegallery.com Laboratory examination ⒊ Bacteriological examination (an important method to definitive diagnosis) : Smear: skin lesions Bacterial culture spun sediment of CSF of blood and CSF Meningococcal meningitisLOGO www.themegallery.com Laboratory examination Figure : Neisseria meningitidis Gram-stain of a pure culture Meningococcal meningitisLOGO www.themegallery.com Diagnosis ⒈ Epidemic season, age and epidemic situations. ⒉ Clinical features. ⒊Manifestations of meningoencephalitis severe form in sepsis and ⒋Increased leukocytes and polymorphonuclear leukocytes predominantly in peripheral blood. ⒌ Increased intracranial pressure and purulent changes in CSF. ⒍ Positive results in bacteriological examination. Meningococcal meningitisLOGO www.themegallery.com Differential diagnosis Purulent meningitis caused by other purulent bacteria. ⑴ Streptococcus pneumonia meningitis, ⑵ Haemophilus influenzae meningitis, ⑶ Staphylococcus aureus meningitis. & (no overt season,no petechae or purpura) ⒉ Meningeal tuberculosis. & (the history, no petechae or purpura,Bacillus tuberculosis) ⒊ Sepsis (Shock type) & (other causative bacteria in blood cultures) ⒈ How to diagnose Meningococcal meningitis www.themegallery.com LOGO 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(39°C) and headache. ◆ Other clinical symptoms included nausea, vomiting, stiff neck and confusion. ◆ There was little petechiate rash emerged on the patient’s four limbs. ◆ The Kernig’s sign was positive and Brudzinski’s sign was negative. ◆ The numbers of white cell in the blood and cerebrospinal fluid (CSF) were 3.6×1010/L and 1.7×109/L, respectively. www.themegallery.com LOGO What was the most likely diagnosis Problems 1 what’s the most likely diagnosis? 2 what do we still do for definitive diagnosis? 3 How to treat this young patient? Towww.themegallery.com analyze the caseLOGO Treatment 1 General treatment ①Isolation hospitalization: ②Careful monitor nursing. ③Prevent complication. ④Maintain the balances of fluid and electrolytes 3 2 Etiological treatment ① Antibacterial activity. ②Concentration in CSF. ③ Resistance to drugs A. Penicillin G (200~400u/kg/day) B.Chloromycetin C.Cephalosporis Other treatment High fever: anti-pyretic (physical chemical) measures. ● Increased intracranial pressure: 20 % mannitol (0.5g/kg~2g/kg) ● www.themegallery.com LOGO Treatment Fulminate type ⑴ Shock type ①Etiology treatment: . Penicillin G ② Shock should be corrected promptly: a. Volume expanded. b. Metabolic acidosis corrected. c. Vasoactive drugs. d. Adrenal corticosteroids. e. Important organs protected ⑵ Meningococcemia-meningitis type ① Effective antibacterial drugs. Penicillin G. ②Alleviate cerebral edema Mannitol and 50 per cent Glucose. ③ Adrenal corticosteroids: Dexamethasone ④ Treatment in respiratory failure: lobeline, coramine ⑤High fever and seizure: Sedatives: wintermine phenergan www.themegallery.com LOGO Meningococcal meningitis Prognosis Good early diagnosed appropriately poor poor Fulminate meningococcemia in the extremes of age treated www.themegallery.com LOGO Meningococcal meningitis 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 Protection of the susceptible population Protect meningococcal vaccines, Chemoprophylaxis Administer Meningococcal meningitis www.themegallery.com LOGO 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 Meningococcal meningitisLOGO www.themegallery.com 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 Meningococcal meningitisLOGO www.themegallery.com Summarization ⒈ Definition Meningococcal meningitis is an acute purulent meningitis caused by meningococci ⒉ Transmission route occurs through respiratory tract. ⒊ The incidence of meningococcal meningitis The incidence of meningococcal meningitis is the first in purulent meningitis among children. Meningococcal meningitisLOGO www.themegallery.com Summarization ⒋ Clinical characteristics ⑴ high fever rapidly; ⑵ severe headache; ⑶ vomiting frequently; ⑷ petechiae and purpura in the skin; ⑸ meningeal irritations; ⑹ infectious shock and injuries in brain parenchyma occurred in severe cases and often result in death. Meningococcal meningitisLOGO www.themegallery.com 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? . Meningococcal meningitisLOGO www.themegallery.com LOGO E-mail: [email protected] Qq: 673162735 LOGO Features of meningococcal meningitis in infants ⒈ Causes of atypical symptoms are that the crania and fontanelle are not still closed and the central nervous system is not well developed. ⒉ The features of clinical manifestations ⑴ Respiratory symptoms always presents with cough. ⑵ Gastroenteric symptoms Refusal to take food, vomiting and diarrhea are common gastroenteric symptoms. ⑶ Increased intracranial pressure includes irritability, shrill, seizures and fullness of the fontanelle. ⑷ Meningeal irritation always is not overt Meningococcal meningitisLOGO www.themegallery.com Features of menigococcal meningitis in the old ⒈ The causes of high incidence in fulminate type In the old the immunity is lower, properdin deficiency and sensitive to endotoxin. ⒉ Clinical manifestations ⑴ Symptoms of upper respiratory tract are commonly presented in the old. ⑵ Mental obtundation is overt. ⑶ Petechia and purpura are more common. ⒊ Complications and prognosis usually can be seen with high mortality. ⒋ Leukocytes Leukopenia is often seen due to lower human body’ reaction Meningococcal meningitisLOGO www.themegallery.com