Meningococcal infections


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Meningococcal infections

  1. 1. •Meningococcal nasopharyngitis•Meningococcemia•Meningitis Charan Tejasvi ML-510
  2. 2.  Neisseria meningitidis (meningococcus) gm (-) diplococcus usually found within PMN leucocytes found only in man
  3. 3. Meningococcal Infections 13 serogroups by surface capsular polysaccharide A, B, C, W135 and Y- frequent isolates from patients with meningococcal diseaseOther groups isolated from carriers
  4. 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. 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. 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. 7. Release of IL Diffuse *Complement DICand TNF vasculitis activation H’ge and necrosis in any organhypotension bleeding into adrenals multi-organ in patients with system septicemia and failure shock Waterhouse- Friderichsen syndrome
  8. 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. 9.  spectrum range from asx’c colonization to fulminant sepsis1. Bacteremia without sepsis2. Meningococcemia (sepsis) without meningitis3. Meningitis with or without meningococcemia
  10. 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 affected mucosa "dry", sometimes bluish).
  11. 11.  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.
  12. 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. 13.  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.
  14. 14.  Eruptions have different colors - red, brown, yellowish-green. In the center of the elements of necrotizing rash. Most often appear large star-shaped form of hemorrhagic lesions with dense infiltrated the base and necrosis in the center.
  15. 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
  16. 16.  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
  17. 17.  (+) 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
  18. 18.  Rapid progression of petechia to ecchymoses or purpura Wakefulness skin perfusion respiratory distress thrombocytopenia advanced age
  19. 19.  Seen in children and adults low grade fever, non toxic appearance, arthralgias, headache , rash, (+) blood culture mean duration of illness: 6-8 weeks
  20. 20. Chronic Meningococcemia Waxing and waning sx purulent arthritis acute non suppurative polyarthritis erythema nodosum URI subacute endocarditis assoc with C5 deficiency
  21. 21. 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
  22. 22. 3. Culture of blood, CSF, petechial scraping, synovial fluid, sputum and other body fluids4. Antigen detection tests (CSF, urine, serum) CIE, latex agglutination, lack adequate sensitivity and specificity
  23. 23. Aq Penicillin G 250,000 -300,000 u/k/day IV 6 div doses x 7 days Alternatives : Cefotaxime 200 mg/k/d Ceftriazone 100-150 mg/k/dayIf allergic to B-lactams : Chloramphenicol 75-100 mg/kg d
  24. 24. ISOLATION: RESPIRATORY isolation until 24° after effective antibiotics
  25. 25. 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)
  26. 26. 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
  27. 27. Vaccines available monovalent A bivalent A and C quadrivalent A, C, Y, W135 no effective vaccine against serogroup B not routinely recommended
  28. 28. Recommended:1. children > 2 yrs.2. In high risk grps. (+) functional /anatomic asplenia, (+) terminal complement component defect + as adjunct to chemoprophylaxis
  29. 29. For Meningitis: deafness ataxia Sz blindness paresis of CN 3,4,6,7, hemi or quadriparesis obstructive hydrocephalus
  30. 30. ComplicationsFor Meningococcemia: Adrenal H’ge, arthritis, myocarditis, pericarditis, pneumonia, lung abscess, peritonitis, renal infarcts, DIC, peripheral neuropathyVasculitis - 2° bacterial infection  tissue necrosis  gangrene  skin loss