MENINGOCOCCAL

MENINGITIS
INTRODUCTION
Meningococcal Meningitis is an acute infectious
type of pyogenic meningitis caused by
Meningococci or Neisseria Meningitidis.
Meningococcus is an aerobic,gram negative
diplococcus which is closely related to
N.Gonnorhea.
DEFINTION
Meningococcal Meningitis or Cerebrospinal fluid
fever is an acute communicable disease caused by
N.Meningitidis.
 PROBLEM STATEMENT
Distribution worldwide,occurring sporadically and in small
outbreaks in most parts of the world.
In some regions, this endemic situation may alternate with
devastating unpredictable epidemics. Eg: African Meningitis belt.
During recent years, several serious outbreaks affecting numerous
countries have occurred in tropical and temperate zones of other
countries have occurred in tropical and temperate zones of other
continents.(America, Asia and Europe)
Meningococcal disease is endemic in India,cases of
meningococcal Meningitis are reported sporadically
or in small clusters.
During the year 2013,about 3,380 cases of
meningococcal Meningitis were reported from only
few states in India with about 176 deaths.
INCUBATION PERIOD
Usually 3 to 4 days, but may vary from 2 to 10 days.
EPIDEMIOLOGICAL DETERMINANTS

Epidemiological Triad
Environment:
Winter Season

Host:
Agent: Humans
Neiserria Meningitidis
AGENT :
Neisseria Meningitidis
HOST :
All ages are susceptible. Younger age groups are more
susceptible than older groups.
ENIVIRONMENTAL FACTORS
Outbreaks usually occur during winter season , predisposed by
factors like overcrowding, poor standard of living condition
and malnutrition. Homogenous communities like nursery
school,day care center, play homes etc.,favor more rapid
spread of the disease.
 MODE OF TRANSMISSION
The disease spreads mainly by droplet infections .
The portal of entry is the nasopharynx.
CLINICAL FEATURES
CLINICAL FEATURES
All cases of meningococcal infections don not develop Meningitis, about 40% become
carriers.The rest develop the following:
MENINGOCOCCEMIA
 A form of septicemia without Meningitis characterized by fever, cough, sore throat
followed by spiking fever, athralgia and myalgia.
 Majority of them develop Petechial Rashes.
FULMINATING MENINGOCOCCEMIA
(WATERHOUSE FRIDERICHSON SYNDROME)
Characterized by Fulminating form of septicemia features being high fever with chills,
severe headache,myalgia,athralgia,widespread petechial eruption associated with shock
followed by coma.
MENINGITIS
 Characterized by fever with chills and cardinal features being headache and
vomiting.
 Vomiting become persistent and Petechial Rashes are usually seen.
 Stiffness of the neck become outstanding, Kernig’s sign and Brudzinski’s signs
become positive.
CHRONIC MENINGOCOCCEMIA
 A rare form of the disease lasting for several weeks to several months.
 Characterized by fever,rash,arthritis,athralgia,fever being intermittent.
 There may be spleenomegaly.
PETECHIAL RASH
LABORATORY DIAGNOSIS
 Examination of CSF
 Blood Culture
 Nasopharyngeal Swab
 Petechial Lesions
 Molecular Diagnosis
PREVENTION AND
CONTROL
CHEMOPROPHYLAXIS
 Rifampicin or Ciprofloxacin is recommended for chemoprophylaxis.
 Rifampicin is given in a dosage of 600mg twice a day for 2 days for adults
and proportionately less for children.
 This is followed by vaccination.
MASS CHEMOPROPHYLAXIS
 Mass treatment causes an immediate drop in the incidence rate of Meningitis
and in the promotion of the carriers.
 Drugs of choice are Ciprofloxacin , Spiramycin and Ceftriazone.
BREAKING THE CHANNEL OF TRANSMISSION
 By avoiding indiscriminate spitting of sputum.
 By improving the living condition.
 By avoiding overcrowding during epidemics.
 By health education.
IMMUNOPROPHYLAXIS
Currently available meningococcal vaccines include:
1. Polysaccharide Vaccine
2. Polysaccharide Protein Conjugate Vaccines
1.POLYSACCHARIDE VACCINES
 Vaccines are available in Bivalent(A,C); Trivalent (A,C,W135) and
Quadrivalent(A ,C , W135 and Y ).
 They are administered as single dose subcutaneous to people greater than 2
years of age.
 Adverse reactions are usually mild.
2.POLYSACCHARIDE PROTEIN CONJUGATE VACCINES
 These Vaccines can be monovalent( A or C ) Or quadrivalent (A ,C ,Y and
W135).
 They are also found in the combination of Haemophilus Influenzae type B
and Neisseria Meningitidis serogroup C Vaccines.
 They are given as IM injections ,preferably in the Deltoid muscle.
TREATMENT
1. CASES
 Treatment with Antibiotics is effective for patients if given within 2
days of illness.
 Antibiotics like Pencillin and Ceftriazone(in case of allergy to
penicillin).
2. CARRIERS
Treatment with pencillin does not eradicate the carrier state; more
powerful antibiotics like Rifampicin are needed to eradicate the carrier
state.
3. CONTACTS
 Antibiotics are effective in preventing additional cases.
 Antibiotics effective for the treatment include:
1. Rifampicin
2. Ciprofloxacin
3. Ceftriazone
4. Azithromycin
COMPLICATIONS
Hydrocephalus
Arthritis
Convulsions
Cardiac complications like Pericarditis,
Endocarditis,Myocarditis.