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.