meningococcal meningitis manifestations.ppt

This is all about meningitis a meningoccocemia bledding disorders in the meninges brief presentation

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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 3.6×10
10
/L and 1.7×10
9
/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
⑴Respiratory tract:
⑵Close contact:
cough/sneeze bosoming/kiss/breast-feed
Meningococcal meningitis

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Epidemiology
Susceptibility
☆Everybodywithoutspecificimmunity
★6monthsto2yearsofage.
Epidemicalfeatures
◇thecommonseason:inthewinterandearlyspring
(NovembertoMayinnextyear)
ThepeakincidenceisinMarchtoApril
Who is at risk?

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Pathogenesis
Immunity＞bacterialquantityandvirulence
A.bacteriaeliminated.
B.benignnasopharyngealcarriage
 orupperrespiratorytractinfection
 →→cured
C.temporalmeningococemia
 →→cured
Meningococcal meningitis

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Pathogenesis
Immunity<bacterialquantityandvirulence
A.meningococcalsepticemia.
B.meningococcalmeningitis.
C.meningococcalarthritisandpericarditis
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:
⒈Meningococcal meningitis(Moderate type)
⒉Fulminate type（shocktype, Meningoencephalitictype)
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
▲intracranialpressure
▲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
⒈Routinelaboratorystudiesofblood:
Meningococcal meningitis
WBC>20×10
9
/LPolymorphonuclear
leukocyte
platelet count(DIC)

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Laboratory examination
Lumbarpuncture:
Meningococcal meningitis
CSF

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Laboratory examination
⒉Cerebrospinal fluid examination
(an important method to establish diagnosis):
●pressure ●glucose
●WBC ●sodium
●protein chloride
Meningococcal meningitis
turbid
>1000×10
6
/L

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Laboratory examination
⒊Bacteriological examination
(an important method to definitivediagnosis):
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 meningitidisGram-stain of a pure culture

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Diagnosis
⒈Epidemicseason,ageandepidemicsituations.
⒉Clinicalfeatures.
⒊Manifestationsofsevereforminsepsisand
meningoencephalitis
⒋Increasedleukocytesandpolymorphonuclear
leukocytespredominantlyinperipheralblood.
⒌Increasedintracranialpressureandpurulentchanges
inCSF.
⒍Positiveresultsinbacteriologicalexamination.
Meningococcal meningitis

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Differential diagnosis
⒈Purulentmeningitiscausedby
otherpurulentbacteria.
⑴Streptococcuspneumoniameningitis,
⑵Haemophilusinfluenzae meningitis,
⑶Staphylococcusaureus meningitis.
＆(no overt season,no petechae or purpura)
⒉Meningealtuberculosis.
＆(thehistory,nopetechaeorpurpura,Bacillustuberculosis)
⒊Sepsis(Shocktype)
＆(othercausativebacteriainbloodcultures)
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 3.6×10
10
/L and 1.7×10
9
/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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Treatment
1
General treatment
①Isolation
hospitalization:
②Careful monitor
nursing.
③Prevent
complication.
④Maintain the
balances of fluid
and electrolytes
2
Etiological treatment
①Antibacterial
activity.
②Concentration
in CSF.
③Resistance to
drugs
A.Penicillin G
（200~400u/kg/day )
B.Chloromycetin
C.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
⑴Shock type
①Etiology treatment:
. Penicillin G
②Shock should be corrected
promptly:
a. Volume expanded.
b. Metabolic acidosis
corrected.
c. Vasoactive drugs.
d. Adrenal corticosteroids.
e. Important organs protected
Fulminate type
⑵Meningococcemia-meningitis
type
①Effective antibacterial drugs.
Penicillin G.
②Alleviate cerebral edema
Mannitol and 50 per cent Glucose.
③Adrenal corticosteroids:
Dexamethasone
④Treatment 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
Protect
Protection of the susceptible population
Protect
Protection of the susceptible population
Administer
meningococcal vaccines, Chemoprophylaxis
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
To 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
⒈Definition
Meningococcal meningitis is an acute purulent meningitis
caused by meningococci
⒉Transmission route
occurs through respiratory tract.
⒊The incidence of meningococcal meningitis
The incidence of meningococcal meningitis is the first in
purulent meningitis among children.
Meningococcal meningitis

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Summarization
⒋Clinicalcharacteristics
⑴highfeverrapidly;
⑵severeheadache;
⑶vomitingfrequently;
⑷petechiaeandpurpuraintheskin;
⑸meningealirritations;
⑹infectiousshockandinjuriesinbrainparenchymaoccurredin
severecasesandoftenresultindeath.
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:
[email protected]
Qq: 673162735

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Features of meningococcal
meningitis in infants
⒈Causes of atypical symptoms
are that the crania and fontanelle are not still closed and the
central nervous system is not well developed.
⒉The features of clinical manifestations
⑴Respiratory symptoms
always presents with cough.
⑵Gastroenteric symptoms
Refusal to take food, vomiting and diarrhea are common
gastroenteric symptoms.
⑶Increased intracranial pressure
includes irritability, shrill, seizures and fullness of the fontanelle.
⑷Meningeal irritation
always is not overt
Meningococcal meningitis

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Features of menigococcal
meningitis in the old
⒈The causes of high incidence in fulminate type
In the old the immunity is lower, properdin deficiency and
sensitive to endotoxin.
⒉Clinical manifestations
⑴Symptoms of upper respiratory tract
are commonly presented in the old.
⑵Mental obtundation
is overt.
⑶Petechia and purpura
are more common.
⒊Complications and prognosis
usually can be seen with high mortality.
⒋Leukocytes
Leukopenia is often seen due to lower human body’ reaction
Meningococcal meningitis