EPIDEMIC CEREBROSPINAL MENINGITIS Dept. Of Infectious Disease Shengjing Hospital.

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Slide 1EPIDEMIC CEREBROSPINAL MENINGITIS Dept. Of Infectious Disease Shengjing Hospital Slide 2 DEFINITION 1. Epidemic cerebrospinal meningitis is acute infectious disease caused by meningococcus. 2.characteristics of ECM are fever, headache, vomiting, petechiae or ecchymosis, and meningeal irritation signs. CSF is purulent. Slide 3 ETIOLOGY 1.Pathogen is Neisseria meningitidis (meningococcus); G - diplococcus. 2.Biological features: 2.1.The organism grow by incubation on 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; Slide 4 Slide 5 2.3. autolysis by autolysin in vitro; 3.The organism can be detected in patients nasopharynx, blood, CSF, petechiae in skin; 4.Pathogenic factor: endotoxin. ETIOLOGY Slide 6 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. ETIOLOGY Slide 7 EPIDEMIOLOGY 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 Slide 8 4.Epidemiologic feature: (1). Season: November - May high peak: March - April (2).age: 6 months to 2 years old EPIDEMIOLOGY Slide 9 PATHOGENESIS meningococci extinguished nasopharynx carriers 60 - 70% upper respiratory tract infection 20 -30% meningococcemia period septicemia pyogenic meningitis 1% Slide 10 Fulminant type endotoxin microcirculatory failure DIC contraction of brain vessel brain edema shock bleeding coma Slide 11 PATHOLOGY PATHOLOGY Septicemic stage: 1. vascular endothelial injury; 2. vascular wall inflammation,necrosis, 3. thrombosis, perivascular bleeding Meningitis stage: 1. Site : leptomeninx, arachnoid 2. congestion, bleeding, swelling of meningeal vessel, Slide 12 PATHOLOGY PATHOLOGY 3. Exudation of fibroprotein, neutrophil and plasma ( CSF is purulent) 4. cranial nerves is injured. Fulminant meningoencephlitis type congestion, bleeding, necrosis and swelling of brain tissue. intracranial hypertension brain hernia Slide 13 CLINICAL MANIFESTATION Incubation 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; Slide 14 Slide 15 Slide 16 Slide 17 CLINICAL MANIFESTATION 3.2.CNS symptoms:headache,vomiting, meningeal irritation: nuchal rigidity;Kerningsigns and Brudzinskisigns are positive. severe case :drowsiness,delirium, and restless merge into coma. Convulsions may occur at any stage of the illness. 4.Convalescent stage:5~7days from Slide 18 CLINICAL MANIFESTATION Fulminant types: 3 forms: 1.shock form:the most dramatic form; 1.1.severe toxic symptoms; 1.2.wildly petechiae, purpura, ecchymosis 1.3.shock :pallor,extremities cold, cyanosis, hypotension, pales quickly 1.4.DIC; 1.5.MOF; Slide 19 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 convulsions 2.3.Intracranial hypertension: CLINICAL MANIFESTATION Slide 20 Severe headache;projectile vomiting; Papillar edema;encephalocele; respiratory failure. 3.mixed type: The mild form: The chronic meningococcemia form: CLINICAL MANIFESTATION Slide 21 Otitis media,purulent arthritis, endocarditis,pericarditis,pneumonia or panophthalmitis. Sequelae: hydro-subdura, hydrocephalus, cranial nerves injured,deafness, blindness,paralysis etc. Complications Slide 22 1.Epidemiologic data: 2.Clinical manifestations: 3.Lab findings; DIAGNOSIS Slide 23 Laboratory Findings: 1.Blood pictures: WBC20x10 9,PLT is decrease in DIC; 2.CSF is suppurative; 3.Bacteriologic diagnosis:smear or culture; 4.Immunologic test:antigen and antibody Slide 24 DIFFERENTIAL DIAGNOSIS 1.Other purulent meningitis; 2.TB MENINGITIS; 3.Epidemic encephalitis B; 4.Septicemia. Slide 25 TREATMENT TREATMENT COMMON TYPE: 1.General treatment: 2.Pathogenic treatment : 2.1.penicillin G: 2.2.Chloramycin: 2.3.Ceftriaxone,Cefotaxime; 3.symptomatic therapy: Slide 26 FULMINANT TYPE 1.SHOCK form: 1.pathogenic therapy; 2.Anti-shock; 3. Steroid;hydrocoticosterone etc; 4. Anti-DIC; 5. Protect major organs; Slide 27 2.Meningoencephalitis: 1. Antibiotics; 2.Decrease intracranial hypertension; 3.Steroid; 4. Anti-respiratory failure; 5. Symptomatic treatment; Slide 28 PREVENTION 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.


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