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MENINGOCOCCAL
MENINGITIS
(Shi Hong)
Department of Infectious Diseases
Meningococcal meningitis
HIGH
● early diagnosis
Morbidity
mortality
Morbidity
● modern
therapy
● supportive
rate
mortality
measure
low
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A case
Beijing Center for Disease Control and Prevention (CDC)
January 11, 2007
◆ The patient was a 14-year-old male student.
◆ The onset of this case started quickly with high fever(39°C)
and headache.
◆ Other clinical symptoms included nausea, vomiting, stiff
neck and confusion.
◆ There was little petechiate rash emerged on the patient’s
four limbs.
◆ The Kernig’s sign was positive and Brudzinski’s sign was
negative.
◆ The numbers of white cell in the blood and cerebrospinal
fluid (CSF) were 3.6×1010/L and 1.7×109/L, respectively.
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What was the most
likely diagnosis
Definition
Meningococcal meningitis :
★ Neisseria meningitides
★ Respiratory tract
★ Purulent meningitis
(an acute inflammation of the membranes that
cover the brain and spinal cord)
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Etiology
◆
◆
◆
◆
gram-negative coccus
Neisseria species
13 serogroups
groups A, B, C
What causes Meningococcal
meningitis
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Epidemiology
Sources of infection:
carriers and patients
Infectious period : between late incubation period and
acute phase, no more than 10 days of onset
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Epidemiology
 Routes of transmission
⑴ Respiratory tract:
⑵ Close contact:
cough/sneeze
bosoming/kiss/breast-feed
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Epidemiology
Susceptibility
☆ Everybody without specific immunity
★ 6 months to 2 years of age.
Epidemical features
◇ the common season : in the winter and early spring
(November to May in next year)
The peak incidence is in March to April
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Who
is at risk?
Pathogenesis

Immunity＞bacterial quantity and virulence
A. bacteria eliminated.
 B. benign nasopharyngeal carriage

or upper respiratory tract infection

→→cured
 C. temporal meningococemia

→→cured

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Pathogenesis
<
 Immunity bacterial quantity and virulence
A. meningococcal septicemia.
 B. meningococcal meningitis.
 C. meningococcal arthritis and pericarditis

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Pathogenesis
Immunity<bacterial quantity and virulence
A. meningococcal septicemia
endothelial cells
invade
release
endotoxin
Petechia
▼infectious
shock
▼acidosis,
▼DIC
▼multiorgans
failure
▼
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Pathogenesis
Immunity＜bacterial quantity and virulence
B. meningococcal meningitis
Neisseria meningitides
the mucosal barrier
the bloodstream
the central nervous system
increased intracranial pressure
convulsion, coma, herniation
CSF turbid, sometimes circular
obstacle of cerebrospinal fluid and hydrocephalus
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Clinical manifestations

petechia in the skin (Meningococcal meningitis)
What are the signs
and symptoms
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Clinical manifestations
 Incubation period: generally 2 to 3 days
(Range is 1 to 10 days)

Four types:
⒈ Meningococcal meningitis (Moderate type)
⒉ Fulminate type（shock type, Meningoencephalitic type)
3. Mixed type （Meningococcemia- meningitis）
4. Mild type (Mild acute meningococcemia)
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signs and symptoms
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Clinical manifestations
Prodromal period
Septic
Septicperiod
period
▲ an
abrupt onset
▲ chills
▲
high fever
Headache
▲ Petechias
▲ purpuras
▲Splenomegaly
Meningitic
Meningitic period
period
▲ intracranial pressure
headache
▲ vomiting
▲ restlessness
▲ Stiff neck
▲ Kernig (+)
▲ brudziski (+)
▲
Convalescent period
▲ gradually disappears,
▲ recovers to normal.
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Clinical
manifestations
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Clinical manifestations
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Laboratory examination
⒈ Routine laboratory studies of blood:
WBC>20×109/L
Polymorphonuclear
leukocyte
platelet count(DIC)
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Laboratory examination
Lumbar puncture:
CSF
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Laboratory examination
⒉ Cerebrospinal fluid examination
(an important method to establish diagnosis) :
turbid
● pressure
● WBC
>1000×10 /L
● protein
6
● glucose
● sodium
chloride
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Laboratory examination
⒊ Bacteriological examination
(an important method to definitive diagnosis) :
Smear: skin lesions
Bacterial culture
spun sediment of CSF
of blood and CSF
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Laboratory examination
Figure : Neisseria meningitidis Gram-stain of a pure culture
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Diagnosis
 ⒈ Epidemic season, age and epidemic situations.
 ⒉ Clinical features.
⒊Manifestations of
meningoencephalitis
severe
form
in
sepsis
and
⒋Increased
leukocytes
and
polymorphonuclear
leukocytes predominantly in peripheral blood.
⒌ Increased intracranial pressure and purulent changes
in CSF.
⒍ Positive results in bacteriological examination.
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Differential diagnosis
Purulent meningitis caused by
other purulent bacteria.
⑴ Streptococcus pneumonia meningitis,
⑵ Haemophilus influenzae meningitis,
⑶ Staphylococcus aureus meningitis.
＆ (no overt season,no petechae or purpura)
⒉ Meningeal tuberculosis.
＆ (the history, no petechae or purpura,Bacillus tuberculosis)
⒊ Sepsis (Shock type)
＆ (other causative bacteria in blood cultures)
⒈
How to diagnose Meningococcal
meningitis
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A case
Beijing Center for Disease Control and Prevention (CDC)
January 11, 2007
◆ The patient was a 14-year-old male student.
◆ The onset of this case started quickly with high fever(39°C)
and headache.
◆ Other clinical symptoms included nausea, vomiting, stiff
neck and confusion.
◆ There was little petechiate rash emerged on the patient’s
four limbs.
◆ The Kernig’s sign was positive and Brudzinski’s sign was
negative.
◆ The numbers of white cell in the blood and cerebrospinal
fluid (CSF) were 3.6×1010/L and 1.7×109/L, respectively.
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What was the most
likely diagnosis
Problems
1
what’s the most likely diagnosis?
2
what do we still do for definitive diagnosis?
3
How to treat this young patient?
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Treatment
1
General treatment
①Isolation
hospitalization:
②Careful monitor
nursing.
③Prevent
complication.
④Maintain the
balances of fluid
and electrolytes
3
2
Etiological treatment
① Antibacterial
activity.
②Concentration
in CSF.
③ Resistance to
drugs
A. Penicillin G
（200~400u/kg/day)
B.Chloromycetin
C.Cephalosporis
Other treatment
High fever:
anti-pyretic
(physical
chemical)
measures.
● Increased
intracranial
pressure:
20 % mannitol
(0.5g/kg~2g/kg)
●
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Treatment
Fulminate type
⑴ Shock type
①Etiology treatment:
. Penicillin G
② Shock should be corrected
promptly:
a. Volume expanded.
b. Metabolic acidosis
corrected.
c. Vasoactive drugs.
d. Adrenal corticosteroids.
e. Important organs protected
⑵ Meningococcemia-meningitis
type
① Effective antibacterial drugs.
Penicillin G.
②Alleviate cerebral edema
Mannitol and 50 per cent Glucose.
③ Adrenal corticosteroids:
Dexamethasone
④ Treatment in respiratory failure:
lobeline, coramine
⑤High fever and seizure:
Sedatives: wintermine phenergan
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Meningococcal
meningitis
Prognosis
Good
early
diagnosed
appropriately
poor
poor
Fulminate
meningococcemia
in the
extremes
of age
treated
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Meningococcal
meningitis
Prevention
isolate
for 3 days after the symptoms disappeared,
generally no less 7 days after the onset
observe
Close contacts:
observed medically for 7 days.
Disrupt
Protect
To
go to theofcrowd
places should
be avoided
Protection
the susceptible
population
during the epidemic
Protection of the susceptible population
Protect
meningococcal vaccines, Chemoprophylaxis
Administer
Meningococcal
meningitis
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Multiple choice
1. A diagnosis of meningococcal infection
requires the following to be present:
a) Headache
b) Neck stiffness
c) Photophobia
d) vomiting
e) Pyrexia
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Multiple choice
2. Meningococci: ( which one is right?)
a) Are most often harmless commensals
colonising the nasopharynx
b) Are carried by some adolescents
who show no signs of disease
c) Are transmitted by aerosol
d) Are usually transmitted with minimal contact
e) Cause infection most frequently in teenagers
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Summarization
⒈ Definition
Meningococcal meningitis is an acute purulent meningitis
caused by meningococci
⒉ Transmission route
occurs through respiratory tract.
⒊ The incidence of meningococcal meningitis
The incidence of meningococcal meningitis is the first in
purulent meningitis among children.
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Summarization
⒋ Clinical characteristics
⑴ high fever rapidly;
⑵ severe headache;
⑶ vomiting frequently;
⑷ petechiae and purpura in the skin;
⑸ meningeal irritations;
⑹ infectious shock and injuries in brain parenchyma occurred in
severe cases and often result in death.
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Summarization
 What is meningitis? What is encephalitis?
What causes meningitis and encephalitis?
Who is at risk for encephalitis and meningitis?
How are these disorders transmitted?
What are the signs and symptoms?
How are meningitis and encephalitis diagnosed?
How are these infections treated?
Can meningitis and encephalitis be prevented?
What is the prognosis for these infections? .
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E-mail:
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Qq: 673162735
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Features of meningococcal
meningitis in infants
⒈ Causes of atypical symptoms
are that the crania and fontanelle are not still closed and the
central nervous system is not well developed.
⒉ The features of clinical manifestations
⑴ Respiratory symptoms
always presents with cough.
⑵ Gastroenteric symptoms
Refusal to take food, vomiting and diarrhea are common
gastroenteric symptoms.
⑶ Increased intracranial pressure
includes irritability, shrill, seizures and fullness of the fontanelle.
⑷ Meningeal irritation
always is not overt
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Features of menigococcal
meningitis in the old
⒈ The causes of high incidence in fulminate type
In the old the immunity is lower, properdin deficiency and
sensitive to endotoxin.
⒉ Clinical manifestations
⑴ Symptoms of upper respiratory tract
are commonly presented in the old.
⑵ Mental obtundation
is overt.
⑶ Petechia and purpura
are more common.
⒊ Complications and prognosis
usually can be seen with high mortality.
⒋ Leukocytes
Leukopenia is often seen due to lower human body’ reaction
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