Meningococcal Infection

Meningococcal infection (Менингококковая инфекция, التهاب السحايا بالمكورات السحائية) is an acute life-threatening bacterial infection caused by several strains of meningococcal bacteria (Neisseria Meningitidis) such as A, B, C, W, X and Y. It is characterized by a sudden onset of fever, headache and neck stiffness. This classic triad of bacterial meningitis is commonly associated with meningitis (inflammation of the meninges or the membranes that cover the brain), but after early-onset Meningococcal infection, patients often progress quickly through the disease stages. In the advanced stages of Meningococcal infection manifestations may include septicemia (blood poisoning) and hemorrhagic rash. If left untreated, septicemia can cause serious complications and may lead to sepsis and death respectively.

Meningococcal bacteria can cause meningitis and septicemia; However, Neisseria meningitidis is the most common cause of bacterial meningitis in the UK, Ireland, Australia and the united states of America.

Classification:

• Primary, localized forms:

1. Meningococcal carriers
2. Meningitis
3. Pneumonia

• Hematogenous–generalized form:

1. Meningococcemia
2. Acutenasopharyngitis
3. Meningoencephalitis
4. Mixed (+ Meningococcemia Meningitis)
5. Rare form (Endocarditis, Arthritis, Iridocyclitis)

 

Pathogen – Neisseria meningitidis.

Epidemiology
• Source of infection – the patient or meningococcal carrier.
• Mechanism of transmission – Meningococcal infection can spread via the aerogenic route, by inhaling aerosol droplets containing the bacteria (Neisseria meningitidis), Less commonly, Meningococcal infection can be transmitted by inhaling air dust particles containing Neisseria meningitidis or by close contact with infected individuals.

Clinical picture

Incubation period ranges from 2 to 10 days.

Meningococcal carriage without any clinical manifestations can last for 7 -14 days. Less commonly, the carrier state may last for 3 weeks or more.

Meningococcal nasopharyngitis

The main difference from other etiologies of nasopharyngitis is that it is accompanied by severe intoxication with follicles presenting on the back of the throat.

Meningococcemia (typical, fulminant and chronic)

Clinical picture

Meningococcemia is characterized by an acute onset, symptoms usually develop suddenly and progresses rapidly.

Pronounced intoxication syndrome it is characterized by systemic symptoms affecting the whole body, These systemic symptoms occur especially in people with more severe forms involving the internal organs. Patients often develop more serious conditions such as heart failure, pneumonia, acute renal failure, adrenal insufficiency, arthritis, etc.

Fever rises to reach 39 – 41 °c, other symptoms alongside temperature include chills, headache, fatigue, weakness, vomiting, hypotension (low blood pressure), pallor and cyanosis of the skin (bluish skin).

Hemorrhagic Syndrome: hemorrhagic rash appears on the first day of illness on the buttocks, legs and trunk, it is characterized by polymorphic irregular shapes (stellate purpuric rash) with areas of necrosis in the center. The emergence of cadaveric Trousseau spots, which is characterized by appearance of bruises on your skin (bruising of the skin) with spots or patches that pass from one place or position to another with the change of body position.
Hepatolienal syndrome is not typical in lightning-fast form where the disease develops quickly and progresses dramatically.

Arthralgia syndrome It occurs in 10% of patients and is characterized by arthritis of the small joints.

Complications: toxic shock.

Differential diagnosis is carried out with staphylococcal sepsis, brucellosis, typhoid fever, typhus, systemic vasculitis, thrombocytopathy and others.

Laboratory diagnosis

In the analysis of blood leukocytosis with a left shift in the ratio of immature to mature neutrophils, an accelerated ESR may also be observed.

Bacteriological method – pathogen isolation from blood, throat swab, scraping of the rash elements.

Serological diagnosis PHA, ELISA and others.

Treatment

Etiotropic therapy: bacteriostatic drugs such as tetracyclines, sulfonamides, chloramphenicol, macrolides, etc. or bactericidal antibiotics such as vancomycin, metronidazole, fluoroquinolones, penicillin, aminoglycosides, cephalosporins, etc.

Pathogenetic therapy – antishock therapy, detoxification therapy.

Symptomatic drugs to treat symptoms.

Meningococcal meningitis

Clinical picture

Meningococcal meningitis is characterized by an acute onset, symptoms usually develop abruptly and progresses quickly.

Intoxication syndrome – see. Section “meningococcemia” above.

Meningeal syndrome is a medical term used to describe a condition characterized by:

1- Intense headache

2- Vomiting that continues with no relief.

3- Neck stiffness (a stiff neck or nuchal rigidity) is a medical term used to describe a condition characterized by ache and difficulty moving the neck.

4- Kernig’s sign is a medical term used to describe a condition characterized by the inability to fully straighten the leg at the knee joint during the pre-bending of the knee and hip joints).

5- Brudzinski’s signs is a medical term used to describe several symptoms of meningeal irritation affecting the whole body, these signs occurs mainly in people with meningitis; however, Brudzinski’s signs can be classified into three main groups:

1. Upper symptoms – Bringing the chin to the chest causes flexion of the lower limbs;
2. Median symptoms – Pressing the pubic bone (pubis) causes flexion of lower extremities;
3. Lower symptoms – Passive flexion of the second lower limb with an active flexion of the first, flexion of the neck causes reflex flexion of the hips and knees.

6- Cutaneous hypersensitivity is a medical term used to describe a condition in which the body reacts with an exaggerated immune response to common triggers.

7- Convulsive state.

Complications syndrome cerebral edema, cerebral hypotension syndrome (intracranial hypotension syndrome, rare).

Differential diagnosis with other etiologies meningitis, subarachnoid hemorrhage, brain tumor.

Laboratory diagnosis

In the analysis of blood leukocytosis accompanied by a left shift in the ratio of immature to mature neutrophils, bacteriology, serology, see. “Meningococcemia”

Analysis of the cerebrospinal fluid – In the Cerebrospinal fluid (CSF) manifestations of purulent meningitis include cloudy and turbid appearance, elevated cytosis with a predominance of neutrophils, glucose very low, elevated protein, and reduced chloride; the ability to detect meningococci in sediment samples.

Treatment

Etiotropic therapy: The drugs of choice is penicillin at a dose of 18 to 36 million units / day, Chloramphenicol 3.0 – 4.0 g/ day.

Pathogenetic and symptomatic therapy, see. “Meningococcemia” above.

Meningoencephalitis – is characterized by brain involvement in the pathological process that often leads to irreversible changes – paresis, paralysis, decreased intelligence.

Verified by: Dr.Diab (January 7, 2017)

Citation: Dr.Diab. (January 7, 2017). Meningococcal Infection Epidemiology symptoms and treatment. Medcoi Journal of Medicine, 17(2). urn:medcoi:article15975.