4 Meningococcal Meningitis
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Transcript of 4 Meningococcal Meningitis
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Department of Infectious Diseases
(Shi Hong)
MENINGOCOCCAL
MENINGITIS
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Meningococcal meningitis
Meningococcal meningitis
Morbidity mortality
rate
Morbidity
mortality
● early diagnosis
● modern
therapy
● supportive
measure
HIGH
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(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.
What was the most likely diagnosis
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DefinitionMeningococcal meningitis :
★ Neisseria meningitides
★ Respiratory tract
★ Purulent meningitis (an acute inflammation of the membranes that
cover the brain and spinal cord)
Meningococcal meningitis
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Etiology◆ gram-negative coccus
◆ Neisseria species
◆ 13 serogroups
◆ groups A, B, C
What causes Meningococcal meningitis
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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
Meningococcal meningitis
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Epidemiology Routes of transmission
⑴ Respiratory tract: ⑵ Close contact:
cough/sneeze bosoming/kiss/breast-feed
Meningococcal meningitis
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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
Who is at risk?
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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
Meningococcal meningitis
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Pathogenesis
Immunity<bacterial quantity and virulence
A. meningococcal septicemia. B. meningococcal meningitis. C. meningococcal arthritis and pericarditis
Meningococcal meningitis
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Pathogenesis
Immunity<bacterial quantity and virulence
A. meningococcal septicemia
Meningococcal meningitis
endothelial cells
endotoxin
▼Petechia▼infectious shock▼acidosis, ▼DIC ▼multiorgans failure
invade
release
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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
Meningococcal meningitis
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Clinical manifestations
What are the signs and symptoms
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: 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 signs and symptoms
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Clinical manifestations
Meningococcal meningitis
Septic period▲ an abrupt onset
▲ chills high fever
▲ Headache
▲ Petechias
▲ purpuras
▲Splenomegaly
Meningitic period
▲ intracranial pressure ▲ headache▲ vomiting ▲ restlessness▲ Stiff neck
▲ Kernig (+)▲ brudziski (+)
▲ gradually disappears,
▲ recovers to normal.
Prodromal period
Septic period Meningitic period
Convalescent period
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Clinical manifestations
Meningococcal meningitis
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Clinical manifestations
Meningococcal meningitis
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Laboratory examination
⒈ Routine laboratory studies of blood:
Meningococcal meningitis
WBC>20×109/L Polymorphonuclearleukocyte
platelet count(DIC)
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Laboratory examination
Lumbar puncture:
Meningococcal meningitis
CSF
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Laboratory examination
⒉ Cerebrospinal fluid examination (an important method to establish diagnosis) :
● pressure ● glucose ● WBC ● sodium ● protein chloride
Meningococcal meningitis
turbid
>1000×106/L
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Laboratory examination
⒊ Bacteriological examination (an important method to definitive diagnosis) :
Meningococcal meningitis
Smear: skin lesions
spun sediment of CSF
Bacterial culture
of blood and CSF
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Laboratory examination
Meningococcal meningitis
Figure : Neisseria meningitidis Gram-stain of a pure culture
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Diagnosis
⒈ Epidemic season, age and epidemic situations.
⒉ Clinical features.
⒊Manifestations of severe form in sepsis and meningoencephalitis
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 meningitis
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Differential diagnosis
⒈ 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)
How to diagnose Meningococcal meningitis
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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(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.
What was the most likely diagnosis
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Problems
what’s the most likely diagnosis?1
what do we still do for definitive diagnosis?
2
How to treat this young patient?3
To analyze the case
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Treatment1
General treatment①Isolation hospitalization: ②Careful monitor nursing. ③Prevent complication.④Maintain the balances of fluid and electrolytes
2
Etiological treatment① Antibacterial
activity.②Concentration
in CSF.③ Resistance to
drugs A. Penicillin G( 200~400u/kg/day)
B.ChloromycetinC.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
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
Fulminate type
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
Meningococcal meningitis
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Prognosis
Fulminate meningo-coccemia
early diagnosed
appropriately
treated
in the extremes of age
Good poor poor
Meningococcal meningitis
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Prevention
ProtectProtection of the susceptible population
ProtectProtection of the susceptible population
Administermeningococcal vaccines, Chemoprophylaxis
isolatefor 3 days after the symptoms disappeared, generally no less 7 days after the onset
observeClose contacts:observed medically for 7 days.
DisruptTo go to the crowd places should be avoided during the epidemic
Meningococcal meningitis
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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
Meningococcal meningitis
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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
Meningococcal meningitis
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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 meningitis
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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 meningitis
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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? .
Meningococcal meningitis
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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 meningitis
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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 meningitis