Presentation on theme: "MENINGOCOCCAL DISEASE 流行性腦脊髓膜炎 馬偕醫院小兒感染科 紀鑫醫師. It commences suddenly with prostration of strength, often extreme: the face is distorted, the pulse feeble."— Presentation transcript:
It commences suddenly with prostration of strength, often extreme: the face is distorted, the pulse feeble. There appears a violent pain in the head, especially over the forehead; then there comes pain of the heart or vomiting of greenish material, stiffness of the spine, and in infants, convulsions. In cases which were fatal, loss of consciousness occurred. The course of the disease is very rapid, termination by death or by cure. In most of the patients who died in 24 hours or a little after, the body is covered with purple spots at the moment of death or very little time afterward. The Disease Which Raged During the Spring of 1805 Gaspard Vieusseux
Epidemiology In the United States, approximately 3000 sporadic cases occur each year. Nasopharyngeal carriage rate: 3-15% Belt across sub-Saharan Africa: 1% In Taiwan, 81 sporadic cases occurred from 1992 to 2000 including 8 fetal cases. In 2001, 30 sporadic cases occurred including 6 fetal cases.
Microbiology Family Neisseriaceae contains five genera: Neisseria Kingella Eikenella Simonsiella Alysiella.
Genus of Neisseria N. gonorrhoeae N. meningitidis N. kochii N. sicca N. lactamica N. subflava N. flavescens N. mucosa N. cinerea N. polysacchreae N. elongata N. macacae N. canis N. dentrificans.
N. meningitidis gram-negative diplococcus, kidney beans, encapsulated facultatively anaerobic, catalase (+) and oxidase (+) autolyse when exposed to drying or sunlight 13 serogroups currently are recognized: A, B, C, D, H, I, K, L, X, Y, Z, W135, and 29E.
Chemical Structure of Group-Specific Polysaccharide Capsules of Meningococci
Serogroups A, B, and C account for more than 90 % of meningococcal disease worldwide. Serogroup A: periodic epidemics in developing countries, is responsible for only 3 % of in the United States. Serogroup B: sporadic disease but occasionally is associated with outbreaks. Serogroup C: associated with numerous outbreaks in the United States, Canada, and Europe. Serotype Y: has been associated with meningococcal pneumonia in military recruits.
The germ is spread by direct contact with secretions from the nose and throat, such as by kissing, coughing, sneezing, and sharing of cigarettes, drinks, and food. Prevalence : winter and spring Incubation period: 1-10 days, most < 4 days
Risk factors inversely to age upper respiratory pathogens smoke and passive smoke family members late complement component deficiencies alternate pathway (properdin) deficiency
Clinical manifestations Serious/Invasive Disease Conjunctivitis Pharyngitis Meningococcal Pneumonia Meningococcal Pericarditis Mesenteric Adenitis and Peritonitis Infections of the Genitourinary Tract Chronic Meningococcemia
Symptoms are usually sudden and initially are like the flu: fever, feeling generally unwell, headache, vomiting, and in some cases a stiff neck. People with this disease are visibly sick and may be confused, excited, or drowsy. Sometimes a reddish-purple rash that may look like bruises appears. Symptoms and Signs
The rash is flat and smooth, does not itch, and may spread quickly once it starts. In rare cases, the symptoms are followed by lowered blood pressure, shock, delirium, sudden extreme weakness, coma, and death. Because the disease spreads quickly in the body, it is important to see a physician immediately if symptoms suggesting meningococcal disease develop.
Signs and Symptoms in Serious Meningococcal Disease
Laboratory findings Leukopenia <5000/ mm 3 : 21 % Thrombocytopenia : 14 % Hyponatremia(SIADH): 7% DIC Acidosis Liver function
Diagnosis Culture: Gold standard Blood culture alone is positive about 50 % Gram stain: Rapid diagnosis Counterimmunoelectrophoresis and latex agglutination: Cross reaction to E. coli or bacillus Polymerase chain reaction : newer tests Specificity : 91 %
Case Definitions for Invasive Meningococcal Disease
Therapy For penicillin-susceptible meningococcemia or meningitis, iv penicillin G, 250,000 units/kg/day every 4 hours for 7 days. Third-generation cephalosporins, ceftriaxone (100 mg/kg/day iv in two divided doses) and cefotaxime (200 mg/ kg/day iv in four divided doses Steroid therapy is controversal
Presenting Features of Meningococcal Infection Associated with Poor Prognosis Presence of petechiae < 12 hours before admission Presence of hypotension (systolic <70 mm Hg) Absence of meningitis (<20 WBC/mm 3 ) Peripheral white blood cell count <10,000/mm 3 Erythrocyte sedimentation rate <10 mm/hour Stiehm, E. R.et al J. Pediatr 1966
Additional prophylactic Rifampin, 10 mg/ kg/dose (maximum, 600 mg/dose) every 12 hours for 2 days Single ceftriaxone (125 mg IM for children 12 years of age)
Disease Risk for Contacts of Index Cases of Invasive Meningococcal Disease