Meningococcal
-Two major meningococcal infections (meningitis and meningioma)
are caused by the gram-negative bacteria Neisseria meningitidis.
-Neisseria meningitidis can infect the meninges. It can also cause
infection of the blood.
-If not treated, meningococcal disease leads to death in 50% of
cases.
-Meningococcal disease refers to any illness caused by bacteria
called Neisseria meningitidis, also known as meningococcus.
-Meningococcal infections may occur sporadically or in epidemics;
virulent infections may be fatal within a matter of hours.
Transmission
-People spread meningococcal bacteria to other people by sharing
respiratory and throat secretions (saliva or spit).
-Transmission takes place through INHALATION of an infected
droplet from carriers.
Prevention
1. V A C C I N A T I O N
Vaccines help protect against all three serogroups (B, C, and Y)
There are 2 types of meningococcal vaccines:
1. Meningococcal conjugate or MenACWY vaccines
(Menactra® and Menveo®)
2. Serogroup B meningococcal or MenB vaccines
(Bexsero® and Trumenba®)
*CDC recommends routine meningococcal conjugate vaccination for:
All preteens and teens at 11 to 12 years old with a booster dose at
16 years old
*CDC recommends routine serogroup B meningococcal vaccination
for
People 10 years or older at increased risk for meningococcal disease
!!!! Who should not get these vaccines? People with severe allergies,
women who is pregnant or breastfeeding, and those who are not
feeling well.
2. A N T I B I O T I C S
Close contacts of a person with meningococcal disease should
receive antibiotics to prevent them from getting sick. Experts call this
prophylaxis.
Incubation Period
-Incubation period is approximately
3 to 4 days
Signs and Symptoms
The most common symptoms include:
Fever
Headache
Stiff neck
>There are often additional symptoms, such as
Nausea & Vomiting
Petechial or purpuric rash
Photophobia (eyes being more sensitive to light)
Altered mental status (confusion)
Diagnosis
-Initial diagnosis of meningococcal meningitis can be made by clinical
examination followed by a lumbar puncture
-The diagnosis is supported or confirmed by growing the bacteria
from specimens of spinal fluid or blood, by agglutination tests or by
polymerase chain reaction (PCR).
Treatment
Doctors treat meningococcal disease with several ANTIBIOTICS. It is
important that treatment start as soon as possible.
Penicillin G
Ampicillin
Cephalosporins – cefoxitin and moxalactam
For those who are allergic to penicillin, chloramphenicol is used.
*Therapy may also include mannitol for cerebral edema.
*IV Heparin for DIC
*Dopamine for shock
*Digoxin and diuretics if develop heart failure
 Supportive measures include:
 Fluid and electrolyte maintenance
 Proper ventilation (patent airway and oxygen if necessary)
 Insertion of arterial or central venous pressure to monitor
cardiovascular status.
 Bed rest
*CHEMOPROPHYLAXIS with rifampicin or minocycline who come in
contact with the patient*
!!! To prevent spread of meningococcal infection, isolate the patient
until the patient has received antibiotic therapy for 24 hours.
*Special considerations:
 The dosage of IV antibiotics should be adjusted as
necessary to maintain blood and CSF drug levels.
 Enforce bed rest in the early stages. Provide a dark, quiet,
restful environment.
 Maintain adequate ventilation with oxygen or a ventilator
if necessary. Suction and turn the patient frequently.
 Keep accurate and take it out put records to maintain
proper fluid and electrolyte levels. Monitor blood
pressure, pulse, ABG and CVP.
 Watch for complication, such as the DIC, arthritis,
endocarditis, and pneumonia.
 If the patient is receiving chloramphenicol, monitor his
CBC.
 Check the patient’s history for allergies before giving
antibiotics.
 Label all meningococcal specimens. Deliver them to the
laboratory quickly because meningococci are very sensitive
to changes in humidity and temperature.
 Report all meningococcal infections to the public health
department officials.
Complications
 DIC
 Vasomotor collapse and shock
 Adrenal hemorrhage and insufficiency
 Meningitis
 Cranial nerve dysfunction, particularly involving the sixth,
seventh, and eighth cranial nerves
 Seizures or deafness in the acute stages of meningitis
 Postmeningitic epilepsy (rare)
 Coma
 Thrombocytopenia
 Septic arthritis
 Herpes labialis (5%-20% of patients with meningococcal
disease)
 Immune complex arthritis involving multiple joints
 Pericarditis due to immunologic reaction or toxin
  DIC
 Vasomotor collapse and shock
 Adrenal hemorrhage and insufficiency
 Meningitis
 Cranial nerve dysfunction, particularly involving the sixth,
seventh, and eighth cranial nerves
 Seizures or deafness in the acute stages of meningitis
 Postmeningitic epilepsy (rare)
 Coma
 Thrombocytopenia
 Septic arthritis
 Herpes labialis (5%-20% of patients with meningococcal
disease)
 Immune complex arthritis involving multiple joints
 Pericarditis due to immunologic reaction or toxin
PNEUMONIA
1. Inflammatory disease of lung; may have a collection of pus
(empyema), fluid (pleural effusion), or consolidation within
pleural space
2. Caused by infectious agent (e.g., bacterial, viral, or fungal)
but also may be caused by inhalation
of chemicals or aspiration of gastric contents
a. Community-acquired pneumonia (CAP): commonly caused by
S. pneumoniae (pneumococcal), H.
influenzae, Legionella pneumophila, M. pneumoniae,
Chlamydia species (C. pneumoniae; C.
psittaci); viruses
b. Ventilator-associated Pneumonia/Hospital-acquired
pneumonia (HAP): commonly caused by S.
aureus, P. aeruginosa, K. pneumoniae, Serratia marcescens, S.
pneumoniae (pneumococcal), H.
influenzae; misuse of antimicrobial agents led to emergence of
resistant strains such as MRSA
c. Aspiration pneumonia: occurs when resident flora of upper
respiratory tract, gastric contents, or
chemicals are aspirated into lung
d. Pneumonias in immunocompromised hosts: commonly
associated with Pneumocystis pneumonia
(PCP) caused by P. jiroveci and other fungal pneumonias (e.g.,
aspergillosis) and M. tuberculosis
e. Severe acute respiratory syndrome (SARS): atypical
pneumonia caused by a coronavirus (SARS-
CoV); 1993 outbreak started in Asia and spread globally
3. Risk factors: age (older adult), COPD, alcoholism, smoking,
neutropenia, ineffective cough,
immobility, HIV infection, endotracheal intubation
3. Pneumonia commonly spread by respiratory dropletS
B. Clinical findings
1. Subjective: lassitude; dyspnea; chest pain that increases on
inspiration
2. Objective
a. Elevated temperature, increased WBCs
b. Chest x-ray shows pulmonary infiltration
c. Cough with sputum production; culture identifies pathogen
(1) Pneumococcal: purulent, rusty sputum
(2) Staphylococcal: yellow, blood-streaked sputum
(3) Klebsiella species: red, gelatinous sputum
(4) Mycoplasmal: nonproductive that advances to mucoid
sputum
C. Treatment
1. Culture and sensitivity tests on blood and sputum to
determine appropriate antibiotic; specimen
must be obtained before antimicrobial therapy is started
2. Antimicrobial therapy initiated within 6 hours of arrival at
hospital: antibiotics, antiviral, or
antifungal therapy; Aspergillus infection is treated with
amphotericin B, azole agents such as
itraconazole (Sporanox), or newer echinocandin agents such as
caspofungin (Cancidas)
3. Respiratory support including oxygen, intubation, and
ventilation as needed
4. Nutritional supplementation and fluid and electrolyte
replacement
5. Bronchodilators
6. Chest physiotherapy and suctioning as needed
7. For SARS: no effective vaccine or treatment identified;
supportive care
8. Global surveillance plan to limit spread (e.g., influenza, SARS)
Planning/Implementation
1. Encourage coughing and deep breathing after chest
physiotherapy, splinting chest as necessary
2. Collect morning sputum specimen for culture and sensitivity
tests in sterile container; notify health
care provider if organism is resistant to antibiotic prescribed
3. Increase fluid intake to 3 L daily to thin secretions
4. Encourage semi-Fowler position
5. Monitor for signs of respiratory distress (e.g., labored
respirations; cool, clammy skin; cyanosis;
and change in mental status)
6. Balance rest periods to conserve oxygen with activity to
mobilize secretions
7. Instruct to cover nose and mouth when coughing; dispose of
tissues in fluid impervious bag
8. Administer prescribed antibiotics
9. Teach preventive measures: role of nutrition and fluids;
avoidance of respiratory irritants and
people with an active respiratory infection; balance of activity
and rest; cessation of smoking; oral
hygiene; need for pneumococcal and influenza vaccinations
(influenza vaccine recommended for
those 50 years or older; pneumococcal vaccine recommended
for those 65 years or older)
10. Follow agency policy regarding transmission-based
precautions
11. Provide nursing care for client with SARS
a. Use contact precautions (e.g., gloves, gowns, and eye
protection); airborne precautions (N-95
disposable respirators)
b. Place in negative-pressure isolation room
c. Have client wear surgical mask until infection control
precautions can be implemented and during
transport in hospital or to home
d. Isolate in home for 10 days after resolution of fever and
respiratory symptoms
e. Teach client and family members transmission-based
precautions to be followed in home
Complications
 Bacteria in the bloodstream (bacteremia). enter the
bloodstream from your lungs can spread the infection
to other organs, potentially causing organ failure.
 Difficulty breathing. - pneumonia is severe or you
have chronic underlying lung diseases, you may have
trouble breathing in enough oxygen. You may need to
be hospitalized and use a breathing machine
(ventilator) while your lung heals.
 Fluid accumulation around the lungs (pleural
effusion). Pneumonia may cause fluid to build up in
the thin space between layers of tissue that line the
lungs and chest cavity (pleura). If the fluid becomes
infected, you may need to have it drained through a
chest tube or removed with surgery.
 Lung abscess. An abscess occurs if pus forms in a
cavity in the lung. An abscess is usually treated with
antibiotics. Sometimes, surgery or drainage with a
long needle or tube placed into the abscess is needed
to remove the pus.