Meningococcal infections

Source of infection: healthy carriers of meningococcal infections or ill persons with mild forms (meningococcal nasopharyngitis).

Classification:

2 large groups.

1. Generalised meningococcal

· Meningococcal sepsis (bacteremia) – meningococcemia (a)

· Meningococcal meningitis (through blood) (b)

· Meningo-encephalitis (c)

· Mixed or combined form (a + b/c)

1. Localised forms:
• Meningococcal pneumonia

Without meningococcemia

Source of infection: above

Route of transmission: Close contact

Droplet

Widely spread in hot countries.

Diagnosis:

Laboratory Examination:

- Blood

- Cerebrospinal fluid

- Mucous from nasopharynx (used for contacts. E.g. Family members)

Spinal puncture in those suspected of meningitis then:

1- Bacteriologic culture

2- Biochemical (glucose, protein, cells)

3- Microscopic examination

- Cells counted in specific films/ camera count inflammatory cells.

- Norm lymphocytes < 17

- If Lymphocytes > meningitis

According to type of cells

- purulent – Neutrophils

- Serotic – Lymphocytes

(↓ Glucose in TB)

Serologic methods:

Detect Ab’s to various types of meningococcal in blood.

A, B, C types of meningitis

Child in hot countries can be vaccinated but only specific vaccination that is only against A, B, C.

Clinical picture:

• Meningococcal Nasopharyngitis

- specificsigns absent

- looks like influenza

- can cause several days without local complications

- this form can change to generalized forms

Treatment: Antibiotics (also carriers because they maybe source of infection)

• Meningococcal meningitis:

- severe headache

- severe intoxication

- throat pain

- subfebrile temperature

- weakness

These are signs of Nasopharyngitis: Temperature

Severe headache

Characteristics of headache:

- severe/ intensive

- diffused (whole head) – grip front with vomiting that doesn’t give good effect accompanied with parasthesia, hyperacousia, phobias (photo, acoustic)

Meningeal signs:

· Bruzinski – Upper, Middle, Lower

· Kroenings

· Occipital rigidity

If 1 or more is positive we can suspect meningitis and we should do spinal puncture.

NB! Spinal puncture is not only diagnostics but also acts as treatment cause:

If meningitis- gets better:, cause after spinal puncture pressure ↓

Therefore if he had ↑ pressure it will be good effect

If meningism – gets worse, if he had normal pressure it will be bad effect (after puncture syndrome)

Infusion of diuretics + Detoxication

If positive result suspect meningitis

If negative result suspect meningism.

Meningitis can occur after trauma

(Positive meningeal signs) insult.

In these cases temperature is normal.

Primary meningitis	Secondary meningitis
Brain is main target of pathogen - meningococcus - pneumococcus   Viral primary meningitis - herpes zoster virus - enterovirus (cocksackie)   Mycobacteria TB   Leptospirosis	Complication of other states. Eg. Sepsis Abscess of brain Otogenic meningitis   Complications after: Disease of ear, oral cavity granulomas, sinusitis Tumour of brain

Examination:

X- Ray of scalp: to exclude Sinusitis

Trauma

Osteomyelitis

No typical specific signs for meningitis, but clinical diagnosis can be made meningococcemia – meningitis can be done because meningococcemia has specific signs – typical rash on skin (hemorrhage rash with irregular form resembling stars)

In center the rash is elevated and see focus of necrosis.

With severe headache + temperature.

Rash has such form cause in meningitis disseminated intravascular syndrome:

1^st phase is hypercoagulation

2^nd phase is hypocoagulation- this large area of bleeding around necrosis.

Localisation of rash is lower extremities, upper extremities, chest, and abdomen. They have various sizes and maybe together with petechial hemorrhage rash.

Rash disappears gradually with scars but which is also disappear (1 month)

Meningococcemia can occur with meningitis or not.

Patients disturbed by Arthalgia- inflammation changes in joints.

Pneumonia can occur from meningococcal etiology.

Complications of meningococcal infections:

1- Disseminated intravenous coagulation syndrome

2- Toxic shock

3- Oedema of brain

4- Coma

5- Secondary epilepsy

6- Encephalopathy

7- Dementic

8- Hydrocephalia

5,6,7,8 – after illness.

E.g. person who suffered with meningococcal infection during childhood this must be observed for 2 years after disease

Treatment:

Lerosethetine (Bacteriostatic) Penniciline – cause endotoxin in large amount move into blood stream and Therefore intensify intoxication.

Then penicillin (if AP normalizes)

2- Penicillin- in all cells of meningococcal infections:

6 million U x 6/ day in 5- 10 days in 5000 U/kg

Diuretics: Manitol, Maninil (to ↓ edema of brain)

Дата добавления: 2015-10-29