Neisseria meningitidis is a gram-negative diplococcus bacteria that can cause meningococcal infection. There are 13 serogroups but groups A, B, C, W135, and Y are most common. Meningococcal infection ranges from asymptomatic colonization to fulminant sepsis and can manifest as meningitis, meningococcemia, or localized infection. Symptoms may include fever, rash, headache, vomiting, and stiff neck. A petechial rash that starts on the lower extremities is particularly indicative of meningococcal infection. Diagnosis involves culture, antigen detection, or gram stain of specimens. Treatment is with intravenous penicillin or other antibiotics. Vacc

1. MENINGOCOCCAL INFECTION
BHAVYA KOGANTI
GROUP 3
TSMU

2. MENINGOCOCCAL INFECTION
 Neisseria meningitidis (meningococcus)
 gm (-) diplococcus usually found
within PMN leucocytes
13 serogroups by surface
capsular polysaccharide
A, B, C, W135 and Y- frequent
isolates.

3.  Disease may occur following exposure
to carriers or infected patients within
the family, day care and military camps
 occurs most frequent:(< 5 yrs old )
peak attack rate : 6-12 months old
 2nd peak attack rate: 15-19 y/o of age
MENINGOCOCCAL INFECTION

4. Meningococci colonize the nasopharynx

penetrate mucosal surface

transported by leukocytes to blood stream

hematogenous dissemination

localizes: heart, CNS, skin, mucous and
serous membranes adrenals

5. Release of IL
and TNF
hypotension
multi-organ
system
failure
Diffuse *Complement DIC
vasculitis activation
H’ge and necrosis in
any organ
bleeding into adrenals
in patients with
septicemia and
shock
Waterhouse-
Friderichsen
syndrome

6.  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)

7.  spectrum range from asx’c colonization to
fulminant sepsis
1. Bacteremia without sepsis
2. Meningococcemia (sepsis) without meningitis
3. Meningitis with or without meningococcemia

8.  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).

9.  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.

10.  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.

11.  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.

12.  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

18.  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

19.  (+) 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

20.  Rapid progression of petechia to ecchymoses
or purpura
 Wakefulness
 skin perfusion
 respiratory distress
 thrombocytopenia
 advanced age

21.  Seen in children and adults
 low grade fever, non toxic appearance, arthralgias,
headache , rash,
 (+) blood culture
 mean duration of illness: 6-8 weeks

22.  Waxing and waning sx
purulent arthritis
acute non suppurative polyarthritis
erythema nodosum
URI
subacute endocarditis
 assoc with C5 deficiency
CHRONIC
MENINGOCOCCEMIA

23. 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

25. 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

26. Aq Penicillin G 250,000 -300,000 u/k/day IV
6 div doses x 7 days
Alternatives :
Cefotaxime
Ceftriazone
200 mg/k/d
100-150 mg/k/day
If allergic to B-lactams :
Chloramphenicol 75-100 mg/kg d

27. Chemoprophylaxis
 for all household, school or day care contacts
ASAP
 NOT ROUTINELY recommended for medical
personnel EXCEPT those with INTIMATE
exposure (mouth to mouth resuscitation,
intubation, suctioning)

28. Chemoprophylaxis
 DOC: Rifampicin 10 mg/kg (max 600 mg) q 12° x
2 days
 other drugs: Ceftriaxone
Ciprofloxacin
 meningococcal vaccine can be used with
chemoprophylaxis since 2° cases may occur several
weeks later

29. Vaccines available
monovalent A
bivalent A and C
quadrivalent A, C, Y, W135
 no effective vaccine against serogroup B
 not routinely recommended

30. Recommended:
1. children > 2 yrs.
2. In high risk grps.
(+) functional /anatomic asplenia,
(+) terminal complement component defect +
as adjunct to chemoprophylaxis

31. For Meningitis:
deafness
ataxia
Sz
blindness
paresis of CN 3,4,6,7,
hemi or quadriparesis
obstructive hydrocephalus

32. 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