Chapter 154 - Gram Negative Coccal and Bacillary Infections Flashcards
(70 cards)
Mortality rates for meningococcal infection in the United States
10% to 15%
Gold standard for diagnosis of meningococcal infection
Culture isolation of N. Meningitidis from blood, CSF, other bodily fluids, or skin biopsy tissues
In the US, vaccination with a capsular polysaccharide conjugate vaccine against serogroups __ is recommended for all patients at ___ with a booster at ___
A, C, W135, Y
11 or 12 years old
16 years old
N. Meningitidis is almost always encapsulated hence allowing differentiation into serogroups based on ___
Capsular polysaccharides
Capsules decrease the visibility of N. Meningitidis via molecular mimicry, best illustrated by serogroup ___
B
Poor prognostic marker for meningococcal infection
High serum lipooligosaccharide (LOS)
Facilitates adherence to endothelial cells, mediate vascular damage, and facilitate breach of blood brain barrier
Type IV pili
Nasopharyngeal carrier rates for
Infants and young children, adolescents, and in young adults.
0.5 to 1%
5%
20 to 40%
In meningitidis, __ have higher risk of infection; while ___ have higher mortality
Males
Females
Matching type
- Meningitis and meningococcemia in infants younger than 6 mos old
- 25% of meningococcal pneumonia in older adults
- Most devastating outbreaks in subSaharan Africa
- Infections with high mortality in subSaharan Africa
- Most recent serogroup to emerge as cause of disease in subSaharan Africa
- 30-40% in US, 80% in Europe
- 30% in US and Europe
Y Y A W135 X B C
Hallmark of acute meningococcemia
Acute petechial rash (60%) in extremities
Petechia were more common in infants than in children or adults.
True or False
False, children 1 to 18 years old (74%) than infants (48%) or adults (45%)
Presence of petechia predicts risk of mortality, but rapid increase in number and size does not correlate with fulminant disease progression.
True or False
False, do not predict risk of mortality but predicts risk of fulminant disease progression
Life threatening condition characterized by adrenal hemorrhage, ensuing adrenal crisis, often accompanied by purpura fulminans.
Waterhouse-Friderichsen syndrome
Most common sequela of meningitis
Sensorineural hearing loss or deafness
Triggers production of proinflammatory cytokines of the innate immune system including IL6, IL8, TNF alpha which contributed to endothelial damage
Lipooligosaccharide (LOS)
Single greatest risk factor for disseminated meningococcal disease
Lack of bactericidal antibodies
- Anatomical or functional asplenia
- HIV infection
- Defects in terminal or alternative complement pathway
CSF findings in meningococcal meningococcal meningitis
CSF leukocytes exceed 100 x 106/L
Elevated protein
Decreased glucose
Direct cause of death from acute meningococcal infection (2)
Shock, multiple organ failure
Single most important factor in treatment of acute meningococcal infection
Early initiation of antibiotics
No more than 30 mins from initiation of antibiotics
Presumptive treatment for meningococcal meningitis
3rd gen cephalosporin
Ceftriaxone or cefotaxime for 7 days
Not beneficial in meningococal meningitis although useful in pneumococcal diseases
Dexamethasone
Droplet precaution should be maintained from presumptive diagnosis until at least __ hours after initiation of effective antibiotic regimen
24
Close contacts are defined as those who have prolonged contact (> ___ hours) within close proximity (< ___ feet) of infected patient or those who had direct exposure to oral secretions from ___ days before the onset of symptoms until ___ hours ff initiation of effective antibiotics
8 hours
3 feet
7 days
24 hours
