Department of Infectious Diseases

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Department of Infectious Diseases
MENINGOCOCCAL MENINGITIS

• (Shi Hong)

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Meningococcal meningitis
HIGH
? early diagnosis ? modern therapy ?
supportive measure

Morbidity mortality
Morbidity mortality
rate
low
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(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.

What was the most likely diagnosis
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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)

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
• ? Respiratory tract
• ? 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

• Immunitygtbacterial 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

• Immunityltbacterial quantity and virulence
• A. meningococcal septicemia.
• B. meningococcal meningitis.
• C. meningococcal arthritis and pericarditis
• 
  
  

Meningococcal meningitis
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Pathogenesis

• Immunityltbacterial quantity and virulence
• A. meningococcal septicemia

endothelial cells
?Petechia ?infectious shock ?acidosis, ?DIC
?multiorgans failure
invade
release
endotoxin
Meningococcal meningitis
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Pathogenesis

• Immunityltbacterial 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

petechia in the skin (Meningococcal meningitis)
What are the signs and symptoms
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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)

What are the signs and symptoms
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Clinical manifestations

Prodromal period
Septic period
Meningitic period
Septic period
Meningitic period
? an abrupt onset ? chills high fever ?
Headache ? Petechias ? purpuras ?Splenomegaly
? intracranial pressure ? headache ? vomiting ?
restlessness ? Stiff neck ? Kernig () ?
brudziski ()
Convalescent period
? gradually disappears, ? recovers to normal.
Meningococcal meningitis
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Clinical manifestations
Meningococcal meningitis
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Clinical manifestations
Meningococcal meningitis
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Laboratory examination

• ? Routine laboratory studies of blood

platelet count(DIC)
WBCgt20109/L
Polymorphonuclear leukocyte
Meningococcal meningitis
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Laboratory examination

• Lumbar puncture

CSF
Meningococcal meningitis
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Laboratory examination

• ? Cerebrospinal fluid examination
• (an important method to establish diagnosis)
  
• ? pressure ? glucose
• ? WBC ? sodium
• ? protein chloride

turbid
gt1000106/L
Meningococcal meningitis
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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
Meningococcal meningitis
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Laboratory examination

Figure   Neisseria meningitidis Gram-stain of a
pure culture
Meningococcal meningitis
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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.

Meningococcal meningitis
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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)

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(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.

What was the most likely diagnosis
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Problems
To analyze the case
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Treatment
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Treatment
Meningococcal meningitis
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Prognosis
Meningococcal meningitis
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Prevention
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

• ? 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.

Meningococcal meningitis
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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.

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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E-mail shihongsysu_at_hotmail.com Qq 673162735

Thank You for your suggestion!
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Thank You !
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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

Meningococcal meningitis
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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

Meningococcal meningitis