Download EPIDEMIC CEREBROSPINAL MENINGITIS

EPIDEMIC
CEREBROSPINAL
MENINGITIS
Dept. Of Infectious Disease
Shengjing Hospital
DEFINITION
1. Epidemic cerebrospinal meningitis is
acute infectious disease caused by
meningococcus.
2.characteristics of
ECM are
headache, vomiting , petechiae
ecchymosis , and
meningeal
signs. CSF is purulent .
fever,
or
irritation
ETIOLOGY
1.Pathogen is Neisseria meningitidis
(meningococcus); Gdiplococcus.
2.Biological features:
2.1.The organism grow by incubation
on blood,chocolate or trypticase soy agar in
5~10%CO2,PH 7.4~7.6;
2.2.The organism is susceptible to dry,
heat , chill and disinfectant;
ETIOLOGY
2.3. autolysis by autolysin in vitro;
3.The organism can be detected
in patient’s nasopharynx, blood,
CSF, petechiae in skin;
4.Pathogenic factor: endotoxin.
ETIOLOGY
5.Serogroups of meningoccus;
 13 serogroups
and
more than
serotypes found in the world;
most common serogroups:

A
B
C group
Group A is the most common in china.
20
EPIDEMIOLOGY
1.Source of infection:

patients and carriers;
2.The routes of transmission :
1) air borne
2) closed contact transmission :
3.Susceptibility of population: universal
susceptible
 stable and persistent immunity
EPIDEMIOLOGY
4.Epidemiologic feature:
(1). Season: November - May

high peak: March - April
(2).age: 6 months to 2 years old
PATHOGENESIS


meningococci
extinguished

nasopharynx
carriers
60 - 70%

upper respiratory tract

infection 20 -30%

meningococcemia period

septicemia
Fulminant type
endotoxin
microcirculatory failure
DIC
contraction of brain vessel
brain edema
shock
coma
bleeding
PATHOLOGY
Septicemic stage:
1. vascular endothelial injury;
2. vascular wall inflammation,necrosis,
3. thrombosis, perivascular bleeding
Meningitis stage:
1. Site : leptomeninx , arachnoid
2. congestion, bleeding, swelling of
meningeal vessel,
PATHOLOGY
3. Exudation of fibroprotein , neutrophil and
plasma ( CSF is purulent)
 4. cranial nerves is injured.
Fulminant meningoencephlitis type
congestion, bleeding, necrosis and
swelling of brain tissue.

intracranial hypertension

brain hernia
CLINICAL MANIFESTATION
Incubation period: 1~10 days(2~3days)
 common type:
1.URT infectious stage:
2.septicemic stage:
 toxemia symptoms;
 petechiae, purpura or ecchymosis.
3.meningitis stage:
3.1.High fever and septicemic symptoms;

CLINICAL MANIFESTATION
3.2.CNS symptoms:headache,vomiting,
 meningeal irritation:

nuchal rigidity;Kerning’signs and

Brudzinski’signs are positive.
 severe case :drowsiness,delirium, and
restless merge into coma.

Convulsions may occur at any stage
of the illness.
4.Convalescent stage:5~7days from
CLINICAL MANIFESTATION
Fulminant types: 3 forms:
1.shock form:the most dramatic form;
1.1.severe toxic symptoms;
1.2.wildly petechiae, purpura, ecchymosis
1.3.shock :pallor,extremities cold, cyanosis,
hypotension, pales quickly
1.4.DIC;
1.5.MOF;
CLINICAL MANIFESTATION
1.6.Meningeal irritant signs is absent,

CSF is normal;
1.7.Blood Culture of meningococcus.
2 . Meningoencephalitis type:
2 .1.fever,toxic symptoms,petechiae;
2 .2.repeated convulsions
2 .3.Intracranial hypertension:
CLINICAL MANIFESTATION
Severe headache;projectile vomiting;
Papillar edema;encephalocele;
respiratory failure.
3.mixed type:
The mild form:
The chronic meningococcemia form:
Complications
Otitis media,purulent arthritis,
endocarditis,pericarditis,pneumonia o
panophthalmitis.
Sequelae:
hydro-subdura, hydrocephalus, crania
nerves injured,deafness,
blindness,paralysis etc.
DIAGNOSIS
1.Epidemiologic data:
2 .Clinical manifestations:
3 .Lab findings;
Laboratory Findings:
1.Blood pictures: WBC20x109,PLT is
decrease in DIC;
2.CSF is suppurative;
3.Bacteriologic diagnosis:smear or

culture;
4.Immunologic test:antigen and
antibody
DIFFERENTIAL DIAGNOSIS
1.Other purulent meningitis;
2 .TB MENINGITIS;
3.Epidemic encephalitis B;
4.Septicemia.
TREATMENT
COMMON TYPE:
1.General treatment:
2 .Pathogenic treatment :
 2 .1.penicillin G:
 2 .2 .Chloramycin:
 2 .3.Ceftriaxone,Cefotaxime;
3.symptomatic therapy:
FULMINANT TYPE
1.SHOCK form:
 1.pathogenic therapy;
 2 .Anti-shock;
 3. Steroid;hydrocoticosterone etc;
 4. Anti-DIC;
 5. Protect major organs;
2 .Meningoencephalitis:
 1. Antibiotics;
 2 .Decrease intracranial
hypertension;
 3 .Steroid;
 4. Anti-respiratory failure;
 5. Symptomatic treatment;
PREVENTION
1.Isolation source of infection;
2.Cut the route of transmission;
3 .Protect susceptible population:
 3.1.Chemoprophylaxis:

SMZ CO or rifampicin;
 3. 2 .Vaccination.