epidemic cerebrospinal meningitis dept. of infectious disease shengjing hospital
TRANSCRIPT
EPIDEMIC EPIDEMIC CEREBROSPINAL CEREBROSPINAL
MENINGITISMENINGITIS Dept. Of Infectious Disease
Shengjing Hospital
DEFINITIONDEFINITION
1. Epidemic cerebrospinal meningitis is acut
e infectious disease caused by
meningococcus.
2.characteristics of ECM are fever,
headache, vomiting , petechiae or ecchy
mosis , and meningeal irritation signs.
CSF is purulent .
ETIOLOGYETIOLOGY
1.Pathogen is Neisseria meningitidis (meningococcus); G- diplococcus.
2.Biological features:2.1.The organism grow by incubationon blood,chocolate or trypticase soy agar in
5~10%CO2,PH 7.4~7.6;2.2.The organism is susceptible to dry,heat , chill and disinfectant;
2.3. autolysis by autolysin in vitro;
3.The organism can be detected
in patient’s nasopharynx, blood,
CSF, petechiae in skin;
4.Pathogenic factor: endotoxin.
ETIOLOGYETIOLOGY
5.Serogroups of meningoccus;
13 serogroups and more than 20
serotypes found in the world;
most common serogroups:
A B C group
Group A is the most common in china.
ETIOLOGYETIOLOGY
EPIDEMIOLOGYEPIDEMIOLOGY
1.Source of infection: patients and carriers; 2.The routes of transmission :1) air borne 2) closed contact transmission : 3.Susceptibility of population: universal
susceptible stable and persistent immunity
4.Epidemiologic feature:(1). Season: November - May high peak: March - April
(2).age: 6 months to 2 years old
EPIDEMIOLOGYEPIDEMIOLOGY
PATHOGENESPATHOGENESISIS meningococci
extinguished nasopharynx carriers 60 - 70% upper respirato
ry tract infection 20 -
30% meningococcemia period
septicemia
pyogenic meningitis 1%
Fulminant type
endotoxin
microcirculatory failure DIC
contraction of brain vessel
brain edema
shock bleeding coma
PATHOLOGYPATHOLOGY
Septicemic stage:1. vascular endothelial injury;2. vascular wall inflammation,necrosis,3. thrombosis, perivascular bleedingMeningitis stage:1. Site : leptomeninx , arachnoid2. congestion, bleeding, swelling of meni
ngeal vessel,
PATHOLOGYPATHOLOGY3. Exudation of fibroprotein , neutrophil and p
lasma ( CSF is purulent) 4. cranial nerves is injured. Fulminant meningoencephlitis typecongestion, bleeding, necrosis andswelling of brain tissue. intracranial hypertension brain hernia
CLINICAL CLINICAL MANIFESTATIONMANIFESTATIONIncubation period: 1~10 days(2~3days)
common type:1.URT infectious stage: 2.septicemic stage: toxemia symptoms; petechiae, purpura or ecchymosis.3.meningitis stage: 3.1.High fever and septicemic symptoms;
CLINICAL MANIFESTATIONCLINICAL MANIFESTATION3.2.CNS symptoms:headache,vomiting, meningeal irritation: nuchal rigidity;Kerning’signs and Brudzinski’signs are positive. severe case :drowsiness,delirium, and
restless merge into coma. Convulsions may occur at any stageof the illness.4.Convalescent stage:5~7days from
CLINICAL MANIFESTATIONCLINICAL MANIFESTATIONFulminant types: 3 forms:1.shock form:the most dramatic form;1.1.severe toxic symptoms;1.2.wildly petechiae, purpura, ecchymosis1.3.shock :pallor,extremities cold, cyanosis, hy
potension, pales quickly1.4.DIC; 1.5.MOF;
1.6.Meningeal irritant signs is absent, CSF is normal;1.7.Blood Culture of meningococcus. 2 . Meningoencephalitis type:2 .1.fever,toxic symptoms,petechiae;2 .2.repeated convulsions2 .3.Intracranial hypertension:
CLINICAL MANIFESTATIONCLINICAL MANIFESTATION
Severe headache;projectile vomiting;Papillar edema;encephalocele;respiratory failure.3.mixed type:The mild form:The chronic meningococcemia form:
CLINICAL MANIFESTATIONCLINICAL MANIFESTATION
Otitis media,purulent arthritis,endocarditis,pericarditis,pneumonia orpanophthalmitis.Sequelae:hydro-subdura, hydrocephalus, cranial
nerves injured,deafness,blindness,paralysis etc.
ComplicationsComplications
1.Epidemiologic data:2 .Clinical manifestations:3 .Lab findings;
DIAGNOSISDIAGNOSIS
Laboratory Findings:Laboratory Findings:
1.Blood pictures: WBC20x109,PLT is decrease in DIC;
2.CSF is suppurative;
3.Bacteriologic diagnosis:smear or
culture;
4.Immunologic test:antigen and antibody
DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS
1.Other purulent meningitis;2 .TB MENINGITIS;3.Epidemic encephalitis B;4.Septicemia.
TREATMENTTREATMENT
COMMON TYPE:1.General treatment:2 .Pathogenic treatment : 2 .1.penicillin G: 2 .2 .Chloramycin: 2 .3.Ceftriaxone,Cefotaxime;3.symptomatic therapy:
FULMINANT TYPEFULMINANT TYPE
1.SHOCK form: 1.pathogenic therapy; 2 .Anti-shock; 3. Steroid;hydrocoticosterone etc; 4. Anti-DIC; 5. Protect major organs;
2 .Meningoencephalitis:2 .Meningoencephalitis:
1. Antibiotics;
2 .Decrease intracranial hypertension;
3 .Steroid;
4. Anti-respiratory failure;
5. Symptomatic treatment;
PREVENTIONPREVENTION
1.Isolation source of infection;2.Cut the route of transmission;3 .Protect susceptible population: 3.1.Chemoprophylaxis: SMZ CO or rifampicin; 3. 2 .Vaccination.