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 •    


 - is an encapsulated
gram-negative diplococcus
 ’cquisition of the organism - results in
asymptomatic pharyngeal colonization or
invasive disease.
 Dissemination of meningococci into the
bloodstream defines meningococcemia and
is a medical emergency..
aathophysiology

 Humans - are the only natural reservoir


 Transmission - by aerosols or
nasopharyngeal secretions.
 Infection is preceded by colonization of the
nasopharynx..
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 ’n outbreak ±
 characterized by the occurrence of 3 or
more cases in a 3-month period
 a primary attack rate of at least 10 cases
per 100,000 population.
 Serogroups ’ and C predominate in ’sia and
’frica.
 Case-fatality rate - is approximately 10% for
meningococcal meningitis and 20% for
meningococcemia despite therapy with
antimicrobial agents.
History
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ahysical
Examination

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^aboratory Studies

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^aboratory Studies

 In meningitis, CSF pressures are elevated,


with elevated protein levels and low glucose
levels.

 Gram-negative diplococci may be observed


in punch biopsy and needle aspiration
specimens of skin lesions.

 aolymerase chain reaction (aCR) is a rapid


method for diagnosing CSF infection.
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Complications
1. CNS ± deafness, seizures, paralysis and
impairment of intellectual function
2. Hydrocephalus ± Va shunt
3. Extensive skin necrosis
4. ^oss of digits or extremities
5. Intestinal hemorrhage
6. ^ate adrenal insufficiency
7. Waterhouse--Freiderichsen syndrome: fulminant
Waterhouse
meningococcemia w/ DIC, massive skin and
mucosal hemorrhages and shock
, 
 
/ / / 
 Semisynthetic derivative of rifamycin B that
inhibits bacterial and mycobacterial RN’
synthesis by binding to beta-subunit of DN’-
dependent RN’ polymerase, thus inhibiting
binding to DN’ and blocking RN’
transcription.
, 
 / 
 ’ 
 600 mg a bid for 2 d

 a 
 Ë1 month: 5 mg/kg a q12h for 2 d
>1 month: 10 mg/kg a q12h for 2 d

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 Treat suspected meningococcal disease with
a high dose in the initial 48 h of therapy
because meningitis is a likely complication.

 a 

 250,000 U/kg/d IV divided q4h


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 Used in patients with penicillin allergy.

 Chloramphenicol binds to 50S bacterial-


ribosomal subunits and inhibits bacterial
growth by inhibiting protein synthesis.
 a 
 50-100 mg/kg/d IV divided q6h


 |eningococcal vaccine

 ’ 
 |CV - for persons ages 11 through 55 years
 0.5 ml I|
 a 
 |aSV - for children 2-10 years old and adults over 55
 0.5 ml I|