1. Microbiology
MENINGOCOCCAL
MENINGITIS

2. • INTRODUCTION
• STATISTICS
• SYMPTOMS
• LAB DIAGNOSIS
• TREATMENT
• PREVENTION
• CONCLUSION
• CASE STUDY
• REFERENCES

3. INTRODUCTION
Meningococcal Meningitis
• Inflammation of membrane covering brain and spinal cord
• Caused by Neisseria meningitidis
• Person to person transmission
• Infect body parts - spread through bloodstream to nervous
system
• Incubation period: 2 to 10 days
• Death and serious complication
Figure 1: Neisseria meningitidis

4. Figure 2 : Difference between normal & abnormal meninges

5. STATISTICS
• Highest case reported in area of sub-Saharan Africa
• In 2009, 14 African country reported with 88199
suspected cases and 5352 deaths
• Largest number since 1996 epidemic

6. SYMPTOMS
• Severe, persistent headache
• Neck stiffness
• Nausea or vomiting
• Drowsiness/difficulty awakening
• Confusion/mental changes
• Purple, bruise-like areas
• Rash, pinpoint red spots
Figure 3: Purple spots

7. LAB DIAGNOSIS
1. Imaging Test (X-rays & CT scans)
• to create pictures of the head, including the skull, brain,
eye sockets, and sinuses.
• reveal swelling or inflammation
2. Blood culture
• Check for the type of bacteria in blood sample
• Type of media: BAP or CAP
• Growth of germs observed
• Gram stain- gram-ve diplococci

8. (b)(a)
Figure 4: (a) CT scan method
(b) Image of brain

9. Figure 5. N. meningitidis colonies on a BAP
• Young colonies-round, smooth, moist, glistening, and convex
• Some colonies appear to coalesce with other nearby colonies

10. Figure 6. N. meningitidis in Gram staining method

11. 3. WBC count
• blood test to measure the number of white blood cells
(WBCs)
• Normal range: 4,500-10,000 WBC per microliter (mcL)
• Affected patients : increased WBC (>10,000 mcL)
4. Lumbar puncture (Spinal tap)
• insertion of a needle into an area in lower spine to drain
cerebrospinal fluid (CSF)
• 5-10mL collected
• CSF - clear fluid (normal)
- cloudy (bacteria present)

12. Figure 7: (a) Lumbar puncture method
(b) Cloudy CSF
(a) (b)

13. 5. CSF glucose, protein test

14. TREATMENT
• Doctor may recommend a broad-spectrum antibiotic until
exact cause of the meningitis determine
• Antibiotics:
(a) Intravenous: ceftriaxone / penicillin
(b) Oral: ciproflaxin / rifampin
• If patient allergic to penicillin - chloramphenicol may be
used
• Steroid – used to prevent hearing loss
• Surgery – to remove accumulated fluid around brain

15. PREVENTION
• All family and close contacts of infected person should
receive antibiotic treatment
• Wash your hands – before handling with foods and after
using toilets
• Cover your mouth - when you need to cough or sneeze
• Vaccines:
(a) Meningococcal polysaccharide vaccines - to control the
disease
(b) Vaccine that provide combined protection against A and C
given to travelers.
(c) Meningococcal B Immunisation for children-to achieve
maximum immunity

16. Figure 8: Hand washing steps

17. CONCLUSION
• Meningitis is a serious diseases- causing inflammation and
swelling of meninges
• 2 types:
(a) bacterial meningitis-more severe, lead to death
(b) viral meningitis- less severe, most people recover fully
• Its present in saliva, commonly transmitted through close
contact.
• Vaccines available to treat and prevent the infection
• Immediate treatment needed- to reduce the severity

19. Patient’s Detail
• A man – 21 year old
• Construction site worker and he had travelled to China a
few days before his illness.
• Fever for one day
• Patient’s BP was 109/50, pulse rate was 115
• Temperature was 38.1 C
• Fully conscious and clinically stable
• Headache, vomiting for three times and severe
dizziness.
• No rash was noted by him

20. Physical Examination
• Generalised maculo-papular rash and a patch of purpura
on the dorsum of the right hand
Figure 9:

21. Cont…
• Suboccipital lymph node was negative.
• No neck rigidity.
• Chest, cardiac and abdominal examination did not reveal
any abnormality.

22. Investigation
• Showed white cell count of 29.1 with neutrophilia.
• Raised CSF protein of 5.45 g/L.
• Decreased CSF glucose of 0.1 mmol/L.
• CSF was turbid with predominating polymorphs.
• Gram Stain was negat ive but culture grew Neisseria
meningitidis
• Was sensitive to cefotaxime, ceftriaxone, chloramphenicol,
ciprofloxacin, penicillin and rifampicin.
• Blood culture grew the same pathogen.

23. Treatment
• Intravenous antibiotic including penicillin G and
cefotaxime were administered
• He recovered without any neurological sequelae.

24. REFERENCES
• Anonymous, (2013), introduction, viewed on 22nd January 2013,
http://www.webmd.com/brain/meningococcal-meningitis-
symptoms-causes-treatments-and-vaccines
• Anonymous, (2012), introduction and symptoms, viewed on 22nd
January 2013,
http://www.nlm.nih.gov/medlineplus/ency/article/000608.htm
• WHO, (2013), statistics, viewed on 22nd January 2013,
http://www.who.int/mediacentre/factsheets/fs141/en/index.html
• Anonymous, (2013), symptoms, viewed on 22nd January 2013,
https://www.healthtap.com/#topics/meningococcal-disease
• Anonymous, (2006), symptoms, viewed on 22nd January 2013,
http://textbookofbacteriology.net/themicrobialworld/meningitis.html
• Lee, G.P.C., Mark, Y.K., Kam, C.K.,(2001), Case report:
meningococcal meningitis. Hong Kong Journal of Emergency
Medicine. 8(2):108-110

25. • Anonymous, (2007),prevention of meningitis, Viewed on 22nd
January 2013, http://www.southerncross.co.nz/HealthResources
• Anonymous, (2012),prevention, Viewed on 22nd January 2013,
http://www. who.int/mediacentre/factsheets
• Anonymous, (2012),test and diagnosis, Viewed on 22nd January
2013, http://www. mayoclinic.com/health/meningitis
• Anonymous, (2008),treatment and prognosis, Viewed on 24th
January 2013,
http://www.path.org/vaccineresources/meningococcus
• Anonymous, (2011),test and diagnosis, Viewed on 24th January
2013, http://www.bestpractice.bmj.com/best-practice/diagnosis/test
• Anonymous, (2013),test and diagnosis, Viewed on 25th January
2013, http://www.meningitisfoundationofamerica.org
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