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56 Cards in this Set

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