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Meningococcal infections

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Tejasvi Charan
Tejasvi Charan

This document discusses Neisseria meningitidis, the bacteria that causes meningococcal disease. It describes how the bacteria colonizes the nasopharynx and can spread to the bloodstream and cerebrospinal fluid, potentially causing meningitis. Symptoms range from mild nasopharyngitis to fulminant sepsis. A petechial or purpuric rash is a hallmark of meningococcal disease. Treatment involves antibiotics, while vaccination and chemoprophylaxis are recommended for close contacts. Complications can include adrenal hemorrhage, arthritis, and tissue necrosis.

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Meningococcal nasopharyngitis Meningococcemia Meningitis Charan Tejasvi ML-510
Neisseria meningitidis (meningococcus) gm (-) diplococcus usually found within PMN leucocytes found only in man
Meningococcal Infections 13 serogroups by surface capsular polysaccharide A, B, C, W135 and Y- frequent isolates from patients with meningococcal disease Other groups isolated from carriers
Meningococcal Infections Common in temperate and tropical climates carriage rates: healthy children 2-5% military personnel (epidemics) 90% transmitted via contact with respiratory secretions
Disease may occur following exposure to carriers or infected patients within the family, day care and military camps occursmost frequent:(< 5 yrs old ) peak attack rate : 6-12 months old 2nd peak attack rate: 15-19 y/o of age
Meningococci colonize the nasopharynx penetrate mucosal surface transported by leukocytes to blood stream hematogenous dissemination localizes: heart, CNS, skin, mucous and serous membranes adrenals
Release of IL Diffuse *Complement DIC and TNF vasculitis activation Hge and necrosis in any organ hypotension bleeding into adrenals multi-organ in patients with system septicemia and failure shock Waterhouse- Friderichsen syndrome
Clinic. The incubation period is from 2 to 10 days (usually 4-6 days). Clinical classification: Localized forms (acute nasopharyngitis) Generalized forms (meningococcemia, meningitis) Rare form (endocarditis, arthritis, pneumonia, iridocyclitis)
spectrum range from asxc colonization to fulminant sepsis 1. Bacteremia without sepsis 2. Meningococcemia (sepsis) without meningitis 3. Meningitis with or without meningococcemia
Manifested a moderate and short-term (1-3 days) increase in temperature, mild symptoms of intoxication rhinopharyngitis (nasal congestion, flushing, dryness, swelling of the posterior pharyngeal wall with hyperplasia of lymphoid follicles affected mucosa "dry", sometimes bluish).
From acute viral disease meningococcal nasopharyngitis different is that the mucous membrane of the soft and hard palate, and tonsils are not impaired or only slightly hyperaemic, but major changes are located on the back of the throat.
Nasopharyngitis preceded meningococcemia at an average of 78% of patients. Meningococcemia is inherently meningococcal sepsis, which, like other septic conditions, appears febrile fever and severe intoxication syndrome with manifestations of multiple organ pathology.
The most important diagnostic symptom is a RASH. after 5-15 hours of onset single or multiple polymorphic elements ranging in size from 2.1 mm to 5 cm or more in diameter and has a hemorrhagic character. asymmetrically, mainly on the skin of the thighs and buttocks, at least - on the trunk and face.
Eruptions have different colors - red, brown, yellowish-green. In the center of the elements of necrotizing rash. Most often appear large star-shaped form of hemorrhagic lesions with dense infiltrated the base and necrosis in the center.
Initially with pharyngitis, fever, myalgias, arthralgias, headache, and GI complaints within hours--> (+) petechial, purpuric (purpura fulminanas) ( slate gray satellite shaped ) or morbilliform lesions with hypotension, DIC, acidosis, adrenal hge, renal/heart failure, coma
Meningococcal infections
Meningococcal infections
Meningococcal infections
Meningococcal infections
Meningococcal infections
If fulminant--> rapidly progressive purpura, relentless shock, adrenal Hge, extensive hematogenous dissemination unresponsive to therapy if with meningitis, (most common clinical manifestation) indistinguishable from those 2属 to other bacteria
(+) petechial < 12属 prior to admission (+) hypotension absence of meningitis WBC < 10,000/mm3 ESR < 10 mm/hr. Interpretation: (+) 3 or > features: 90% mortality > 2 features; 9% mortality
Rapid progression of petechia to ecchymoses or purpura Wakefulness skin perfusion respiratory distress thrombocytopenia advanced age
Seen in children and adults low grade fever, non toxic appearance, arthralgias, headache , rash, (+) blood culture mean duration of illness: 6-8 weeks
Chronic Meningococcemia Waxing and waning sx purulent arthritis acute non suppurative polyarthritis erythema nodosum URI subacute endocarditis assoc with C5 deficiency
1. Maintain a high index of suspicion (fever, petechial rash, abn mental status) 2. Gm stain of petechial scrapings CSF buffy coat of blood; gm (-) diplococci
Meningococcal infections
3. Culture of blood, CSF, petechial scraping, synovial fluid, sputum and other body fluids 4. Antigen detection tests (CSF, urine, serum) CIE, latex agglutination, lack adequate sensitivity and specificity
Aq Penicillin G 250,000 -300,000 u/k/day IV 6 div doses x 7 days Alternatives : Cefotaxime 200 mg/k/d Ceftriazone 100-150 mg/k/day If allergic to B-lactams : Chloramphenicol 75-100 mg/kg d
ISOLATION: RESPIRATORY isolation until 24属 after effective antibiotics
Chemoprophylaxis for all household, school or day care contacts ASAP or within 24属 from diagnosis of 1属 case NOT ROUTINELY recommended for medical personnel EXCEPT those with INTIMATE exposure (mouth to mouth resuscitation, intubation, suctioning)
Chemoprophylaxis DOC: Rifampicin 10 mg/kg (max 600 mg) q 12属 x 2 days other drugs: Ceftriaxone Ciprofloxacin meningococcal vaccine can be used with chemoprophylaxis since 2属 cases may occur several weeks later
Vaccines available monovalent A bivalent A and C quadrivalent A, C, Y, W135 no effective vaccine against serogroup B not routinely recommended
Recommended: 1. children > 2 yrs. 2. In high risk grps. (+) functional /anatomic asplenia, (+) terminal complement component defect + as adjunct to chemoprophylaxis
For Meningitis: deafness ataxia Sz blindness paresis of CN 3,4,6,7, hemi or quadriparesis obstructive hydrocephalus
Complications For Meningococcemia: Adrenal Hge, arthritis, myocarditis, pericarditis, pneumonia, lung abscess, peritonitis, renal infarcts, DIC, peripheral neuropathy Vasculitis - 2属 bacterial infection tissue necrosis gangrene skin loss
Meningococcal infections
Meningococcal infections
Meningococcal infections

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Meningococcal infections

  • 2. Neisseria meningitidis (meningococcus) gm (-) diplococcus usually found within PMN leucocytes found only in man
  • 3. Meningococcal Infections 13 serogroups by surface capsular polysaccharide A, B, C, W135 and Y- frequent isolates from patients with meningococcal disease Other groups isolated from carriers
  • 4. Meningococcal Infections Common in temperate and tropical climates carriage rates: healthy children 2-5% military personnel (epidemics) 90% transmitted via contact with respiratory secretions
  • 5. Disease may occur following exposure to carriers or infected patients within the family, day care and military camps occursmost frequent:(< 5 yrs old ) peak attack rate : 6-12 months old 2nd peak attack rate: 15-19 y/o of age
  • 6. Meningococci colonize the nasopharynx penetrate mucosal surface transported by leukocytes to blood stream hematogenous dissemination localizes: heart, CNS, skin, mucous and serous membranes adrenals
  • 7. Release of IL Diffuse *Complement DIC and TNF vasculitis activation Hge and necrosis in any organ hypotension bleeding into adrenals multi-organ in patients with system septicemia and failure shock Waterhouse- Friderichsen syndrome
  • 8. Clinic. The incubation period is from 2 to 10 days (usually 4-6 days). Clinical classification: Localized forms (acute nasopharyngitis) Generalized forms (meningococcemia, meningitis) Rare form (endocarditis, arthritis, pneumonia, iridocyclitis)
  • 9. spectrum range from asxc colonization to fulminant sepsis 1. Bacteremia without sepsis 2. Meningococcemia (sepsis) without meningitis 3. Meningitis with or without meningococcemia
  • 10. Manifested a moderate and short-term (1-3 days) increase in temperature, mild symptoms of intoxication rhinopharyngitis (nasal congestion, flushing, dryness, swelling of the posterior pharyngeal wall with hyperplasia of lymphoid follicles affected mucosa "dry", sometimes bluish).
  • 11. From acute viral disease meningococcal nasopharyngitis different is that the mucous membrane of the soft and hard palate, and tonsils are not impaired or only slightly hyperaemic, but major changes are located on the back of the throat.
  • 12. Nasopharyngitis preceded meningococcemia at an average of 78% of patients. Meningococcemia is inherently meningococcal sepsis, which, like other septic conditions, appears febrile fever and severe intoxication syndrome with manifestations of multiple organ pathology.
  • 13. The most important diagnostic symptom is a RASH. after 5-15 hours of onset single or multiple polymorphic elements ranging in size from 2.1 mm to 5 cm or more in diameter and has a hemorrhagic character. asymmetrically, mainly on the skin of the thighs and buttocks, at least - on the trunk and face.
  • 14. Eruptions have different colors - red, brown, yellowish-green. In the center of the elements of necrotizing rash. Most often appear large star-shaped form of hemorrhagic lesions with dense infiltrated the base and necrosis in the center.
  • 15. Initially with pharyngitis, fever, myalgias, arthralgias, headache, and GI complaints within hours--> (+) petechial, purpuric (purpura fulminanas) ( slate gray satellite shaped ) or morbilliform lesions with hypotension, DIC, acidosis, adrenal hge, renal/heart failure, coma
  • 21. If fulminant--> rapidly progressive purpura, relentless shock, adrenal Hge, extensive hematogenous dissemination unresponsive to therapy if with meningitis, (most common clinical manifestation) indistinguishable from those 2属 to other bacteria
  • 22. (+) petechial < 12属 prior to admission (+) hypotension absence of meningitis WBC < 10,000/mm3 ESR < 10 mm/hr. Interpretation: (+) 3 or > features: 90% mortality > 2 features; 9% mortality
  • 23. Rapid progression of petechia to ecchymoses or purpura Wakefulness skin perfusion respiratory distress thrombocytopenia advanced age
  • 24. Seen in children and adults low grade fever, non toxic appearance, arthralgias, headache , rash, (+) blood culture mean duration of illness: 6-8 weeks
  • 25. Chronic Meningococcemia Waxing and waning sx purulent arthritis acute non suppurative polyarthritis erythema nodosum URI subacute endocarditis assoc with C5 deficiency
  • 26. 1. Maintain a high index of suspicion (fever, petechial rash, abn mental status) 2. Gm stain of petechial scrapings CSF buffy coat of blood; gm (-) diplococci
  • 28. 3. Culture of blood, CSF, petechial scraping, synovial fluid, sputum and other body fluids 4. Antigen detection tests (CSF, urine, serum) CIE, latex agglutination, lack adequate sensitivity and specificity
  • 29. Aq Penicillin G 250,000 -300,000 u/k/day IV 6 div doses x 7 days Alternatives : Cefotaxime 200 mg/k/d Ceftriazone 100-150 mg/k/day If allergic to B-lactams : Chloramphenicol 75-100 mg/kg d
  • 30. ISOLATION: RESPIRATORY isolation until 24属 after effective antibiotics
  • 31. Chemoprophylaxis for all household, school or day care contacts ASAP or within 24属 from diagnosis of 1属 case NOT ROUTINELY recommended for medical personnel EXCEPT those with INTIMATE exposure (mouth to mouth resuscitation, intubation, suctioning)
  • 32. Chemoprophylaxis DOC: Rifampicin 10 mg/kg (max 600 mg) q 12属 x 2 days other drugs: Ceftriaxone Ciprofloxacin meningococcal vaccine can be used with chemoprophylaxis since 2属 cases may occur several weeks later
  • 33. Vaccines available monovalent A bivalent A and C quadrivalent A, C, Y, W135 no effective vaccine against serogroup B not routinely recommended
  • 34. Recommended: 1. children > 2 yrs. 2. In high risk grps. (+) functional /anatomic asplenia, (+) terminal complement component defect + as adjunct to chemoprophylaxis
  • 35. For Meningitis: deafness ataxia Sz blindness paresis of CN 3,4,6,7, hemi or quadriparesis obstructive hydrocephalus
  • 36. Complications For Meningococcemia: Adrenal Hge, arthritis, myocarditis, pericarditis, pneumonia, lung abscess, peritonitis, renal infarcts, DIC, peripheral neuropathy Vasculitis - 2属 bacterial infection tissue necrosis gangrene skin loss