Meningococcal Infections

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Meningococcal
infections
Tejasvi Charan
Mar. 25, 2013 • 50 likes • 15,387 views
 19 of 39  
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Meningococcal infections
1.
•Meningococcal nasopharyngitis •Meningococcemia
•Meningitis
Charan Tejasvi ML-510
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 Di"use *Complement DIC and TNF
vasculitis activation H’ge 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 asx’c 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 a"ected mucosa "dry", sometimes
bluish).
11. From acute viral disease meningococcal
nasopharyngitis di"erent is that the mucous membrane of
the so# 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”. a#er 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 di"erent colors - red, brown,
yellowish-green. In the center of the elements of
necrotizing rash. Most o#en 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 h’ge, renal/heart failure, coma
21. If fulminant--> rapidly progressive purpura, relentless
shock, adrenal H’ge, extensive hematogenous
dissemination unresponsive to therapy if with
meningitis, (most common clinical manifestation)
indistinguishable from those 2° to other bacteria
22. (+) petechial < 12° 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 bu"y 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 Ce#riazone
100-150 mg/k/day If allergic to B-lactams :
Chloramphenicol 75-100 mg/kg d
30. ISOLATION: RESPIRATORY isolation until 24° a#er
e"ective antibiotics
31. Chemoprophylaxis for all household, school or day
care contacts ASAP or within 24° from diagnosis of 1° 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° x 2 days other drugs: Ce#riaxone
Ciprofloxacin meningococcal vaccine can be used with
chemoprophylaxis since 2° cases may occur several weeks
later
33. Vaccines available monovalent A bivalent A and C
quadrivalent A, C, Y, W135 no e"ective 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 H’ge,
arthritis, myocarditis, pericarditis, pneumonia, lung
abscess, peritonitis, renal infarcts, DIC, peripheral
neuropathy Vasculitis - 2° bacterial infection tissue
necrosis gangrene skin loss
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