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56 Cards in this Set
- Front
- Back
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What was once called malignant purpuric fever?
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Meningococcus
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What tye of bacteria is N. meningitidis?
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Gram negative diplooccus
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What does Neisseria meningitids cause?
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Sepsis
Meningitis |
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What seasonal pattern is seen with N. meningitidis?
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With influenza season (possibly a secondary infection in injured lung tissues)
In dry season in africa, due to crowding/people cooling off inside |
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Who gets meningococcal dz?
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Children under 15
Males |
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How often are epidemics of meningitis seen in meningitis belt?
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Every 10 years or so
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What is meningitis mortality rate in epidemic (without abx)
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90%
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Do medical personnel acquire meningitis from patients/
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Rare except with mouth to mouth
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How is meningococcus spread?
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Respiratory, mostly from asymptomatic carriers
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What is the secondary attack rate of meningitis?
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2-4/1000 (within 96 hours of first case)
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Can people be chronic meningococcus carriers?
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Yes
Carriage can last for weeks Increases with age |
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Where does meningococcus like to hang out?
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Posterior pharynx (90% of cases limited to here with mild bacteremia)
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What causes the clinical symptoms in meningococcus meningitis?
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Tissue injury from the endotoxin on the lipopolysaccharide coat
Causes increased permeability of blood brain barrier -- thus the meningitis Necrosis caused by thrombi and vasculitis Endotoxin can be released after antibiotics, too |
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What are the 5 types of disease from meningococcus you might see?
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Mild bacteremia
Meningitis Mild meningoccemia Fulminant meningococcemia Chronic meningococcemia |
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Does meningitis in N. meningitis infection predict death?
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Actually no
Meningitis is considered a "localized" reaction -- less deadly that disseminated |
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Sx of mild menigoccocal bacteremia
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Maybe fever
Arthralgias Pink rubella-like rash Sx regress for several days, then are followed with more severe disease |
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What are the localized sx of meningococcus seen in mild bacteremia?
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Meningitis
epididymitis arthritis Pneumonitis Conjunctivitis Myocarditis |
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What is Waterhouse Friedrickson syndrome?
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Bleeding into the adrenal glands for menigoccus dz
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What sx is more common in meningococcal meningitis (vs other types)
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Myalgias
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What is the ddx of petechial rash?
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Meningococcemia
Staph endocarditis Rocky Mountain Spotted Fever Dengue Hemorrhagic fever TTP |
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Are cerebral findings of meningitis reversible?
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Yes, with prompt treatment
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What is a common sequelae of meningoccus meningitis?
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Deafness
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What does petechia reflect?
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Platelet problems
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What does purpura reflect?
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Clotting factor problems and vasculitis
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What is the most common presentation of meningoccal infection?
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Mild meningococcemia
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Sx of mild menigoccocal bacteremia
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Maybe fever
Arthralgias Pink rubella-like rash Sx regress for several days, then are followed with more severe disease |
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What are the localized sx of meningococcus seen in mild bacteremia?
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Meningitis
epididymitis arthritis Pneumonitis Conjunctivitis Myocarditis |
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What is Waterhouse Friedrickson syndrome?
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Bleeding into the adrenal glands for menigoccus dz
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What sx is more common in meningococcal meningitis (vs other types)
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Myalgias
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What is the ddx of petechial rash?
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Meningococcemia
Staph endocarditis Rocky Mountain Spotted Fever Dengue Hemorrhagic fever TTP |
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Are cerebral findings of meningitis reversible?
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Yes, with prompt treatment
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What is a common sequelae of meningoccus meningitis?
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Deafness
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What does petechia reflect?
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Platelet problems
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What does purpura reflect?
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Clotting factor problems and vasculitis
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What is the most common presentation of meningoccal infection?
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Mild meningococcemia
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What are the sx of mild meningococcemia?
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Petechial rash and fever
May progressto ecchymosis/shock After 1 week, may develop joint effusions |
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What percent of meningococcal infection is fulminant?
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10%
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Sx of fulminant meningococcal infection
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Petechia into purpura
High fever Dizzy, rigors, weakness, hypotension/shock DIC |
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What may mimick fulminant meningococcal infection
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Group A strep
Staph sepsis Gram negative sepsis |
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What are poor prognostic signs of meningococcal infection - fulminant
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etechia <12 hours prior to hospitalization
Absence of meningitis Temp >40c Shock Leukoenia Low platelets Extremes of age |
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What is seen in chronic meningococcemia?
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Rare
Intermittent fevers of 1-6 days, recurrent over weeks 20% get splenomegaly and meningitis Migratory arthralgias, polyymorphous rash Blood cx only positive when febrile |
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How to dx meningococcal infection
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Blood culture 50-75% +
SPinal tap if meningeal signs Gram stain of CSF (BEST TEST) Latex agglutination Gram stain/cx buffy coat |
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Where does meningococcus grow in lab?
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Enriched agars (Thaer martin or chocolate), high CO2
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How to treat meningococcal infection
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Emergency -- treat quickly
Respiratory isolation x24 hours Rocephin pending cx After confirmation, high dose pcn or amp x 7d |
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Supportive care for meningococcal infection
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Maintain oxygenation
Reverse acidosis Maintain BP (dopamine, fluids) Correct CHF (diuretic) Control seizures Dex with meningitis to reduce risk deafness |
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How to reduce risk deafness with meningococcal meningitis?
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Treat with steroids
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What do you see with absent spleen and meningococcal infection
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Chronic meningococcemia
Hirhg risk of infection |
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How to control infection?
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Immunize (if approp vaccine serogroup)
Rifampin or rocephin or cipro prophylaxis (sulfa resistance) |
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Problem with rifampin prophylaxis of meningococcal infection
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Doesn't treat
25% resistance Orange tears/urine |
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Dose for rifampin prophylaxis of meningococcal infection
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Treat household/school contacts
Adults 600mg bid x 2d Child: 10mg/kg/d x 4 |
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How many serogroups in the polysaccharide vaccine for meningococcal infection
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A, c,y, W135
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What were the most common serotypes of meningococcal infection in Africa till 2000
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A, C (now X, W135 has been seen)
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At what age can you get the polysaccharide vaccine for meningococcal infection
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>2 years old (90% effective if >1 year old)
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What is the best vaccine for kids in meningococcal infection
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Conjugate vaccine (>2 y/o)
helps kids get immunity, by tacking a carrier molecule to polysaccharide so kids' immune systems can ID. |
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What's true about children <2 and polysaccharide vaccines?
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Kids don't make good immunity to polysaccharide capsule
Need conjugate vaccine |
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Do vaccines for meningococcal infection give lifelong immunity?
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No, only about a year long in some cases
Good for outbreaks |
