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EPIDEMIC CEREBROSPINAL MENINGITIS Dept. Of Infectious Disease Shengjing Hospital.

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Presentation on theme: "EPIDEMIC CEREBROSPINAL MENINGITIS Dept. Of Infectious Disease Shengjing Hospital."— Presentation transcript:

1 EPIDEMIC CEREBROSPINAL MENINGITIS Dept. Of Infectious Disease Shengjing Hospital

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.

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;

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5  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. ETIOLOGY

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

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

8  4.Epidemiologic feature:  (1). Season: November - May  high peak: March - April  (2).age: 6 months to 2 years old EPIDEMIOLOGY

9 PATHOGENESIS  meningococci  extinguished  nasopharynx carriers %  upper respiratory tract  infection %  meningococcemia period  septicemia  pyogenic meningitis 1%

10 Fulminant type endotoxin microcirculatory failure DIC contraction of brain vessel brain edema shock bleeding coma

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,

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

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; 

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17 CLINICAL MANIFESTATION  3.2.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 stage  of the illness.  4.Convalescent stage:5~7days from

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;

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

20  Severe headache;projectile vomiting;  Papillar edema;encephalocele;  respiratory failure.  3.mixed type:  The mild form:  The chronic meningococcemia form: CLINICAL MANIFESTATION

21  Otitis media,purulent arthritis,  endocarditis,pericarditis,pneumonia or  panophthalmitis.  Sequelae:  hydro-subdura, hydrocephalus, cranial nerves injured,deafness,  blindness,paralysis etc. Complications

22  1.Epidemiologic data:  2.Clinical manifestations:  3.Lab findings; DIAGNOSIS

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

24 DIFFERENTIAL DIAGNOSIS  1.Other purulent meningitis;  2.TB MENINGITIS;  3.Epidemic encephalitis B;  4.Septicemia.

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:

26 FULMINANT TYPE  1.SHOCK form:  1.pathogenic therapy;  2.Anti-shock;  3. Steroid;hydrocoticosterone etc;  4. Anti-DIC;  5. Protect major organs;

27 2.Meningoencephalitis:  1. Antibiotics;  2.Decrease intracranial hypertension;  3.Steroid;  4. Anti-respiratory failure;  5. Symptomatic treatment;

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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