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intro to clinical sciences phase 2 > invasive meningoccal disease > Flashcards

invasive meningoccal disease Flashcards

1
Q

what is meningitis

A

inflammation of the meninges (membranes) which cover the brain and spinal cord

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2
Q

what are the 3 layers of meninges

A

dura mater
arachnoid mater
pia mater

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3
Q

usual causes of meningitis

A

infection with
- bacteria
- viruses
- less common ones: fungi, protoza &other parasites

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4
Q

non infectious causes of meningitis

A
  • medications eg antibiotics, NSAIDS
  • cancers eg melanoma, lung cancer
  • autoimmune diseases eg SLE, Behcets syndrome
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5
Q

differential diagnoses for acute bacterial meningitis

A

• Viral meningitis
• Fungal meningitis
• TB meningitis
• Drug-induced meningitis Loading…
• Sepsis from other causes
• Encephalitis – inflammation of the brain
• Brain abscess – collection of pus in the brain
• Subarachnoid haemorrhage
• Brain tumour
• HIV infection

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6
Q

what is invasive meningococcal disease

A

infection with NEISSERIA MENINGITIDIS

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7
Q

describe neisseria meningitidis

A

gram negative dipolococci
carried by 10-24% of population
humans are the only known reservoir

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8
Q

describe transmittion of neisseria meningitidis

A

by respiratory droplets/nano-pharyngeal secretions

usually requires either frequent or prolonged close contact

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9
Q

incubation period of neisseria meningitidis

A

2- 10 days

usually 3-4 days

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10
Q

2 main manifestations of neisseria meningitidis

A

meningitis - a localised infection of the meninges with ‘local’ symptoms

septicaemia - a systemic infection with widespread signs, and generalised organ damage

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11
Q

how many sero groups of neisseria mengitidis

A

12 sero groups based on the capsular polysaccharide

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12
Q

when is meningitis more prominently

A

winter

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13
Q

which is worse - bacterial or viral meningitis

A

viral

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14
Q

risk factors for invasive meningococcal disease

A

Extremes of age
• Immunocompromised (e.g. HIV) or immunosuppressed (e.g. chemotherapy)
• Asplenia/hyposplenia
• Cancer – people with leukaemia and lymphoma
• Sickle cell disease
• Organ dysfunction – e.g. liver or kidney disease
• Cranial anatomical defects
• Cochlear implants
• Contiguous infection - e.g. otitis media, sinusitis, mastoiditis, pneumonia
• Smokers
• Living in overcrowded households, college dormitories or military barracks
• People who have had contact with a case
• Travellers abroad to high risk area - increased risk of encountering the pathogen

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15
Q

classic symptoms of meningococcal meningitis

A

fever
stiff neck
headache
confusion
increased sensitivity to light
nausea and vomiting

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16
Q

babies symptoms of meningococcal meningitis

A

slow or inactive
irritable
vomiting
feeding poorly
bulging anterior fontanelle - soft spot of the skull

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17
Q

meningococcal septicaemia symptoms

A
  • fever and chills
  • fatigue
  • vomiting
  • cold hands & feet
  • severe aches or pains in the muscles, joints, chest or abdomen
  • rapid breathing
  • diarrhoea
  • nom blanching rash (petechiae)
  • in later stage - a dark purple rash (purpura)
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18
Q

what happens if you press a glass against a petechiae rash

A

the rash does not fade if you press the side of a clear glass firmly against the skin

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19
Q

what can sepsis cause

A

Disseminated intravascular coagulation - the activation of coagulation pathways that results in formation of intravascular thrombi and depletion of platelets and coagulation facors

these clots cause arterial occlusionsleading to gangrene of extremities & auto amputations

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20
Q

natural history of disease

A

acute onset

fulminating infection - occurs quickly, escalates uickly

prolonged and persistent coccaemia (bloodstream infection)

surovioprs may have long term complications -eg deafness, amputations, seizures

21
Q

what specimens do you take on hospital admission before initiating antibodies

A

blood sample for culture & PCR
CSK for microscopy, culture and PCR

for other localised infections - aspirate from sterile site for microscopy, culture and PCR

throat swab for culture

additional samples for enhanced national surveillance

22
Q

why do you notify public health about the disease

A

To find out how the patient caught it

23
Q

when do you notify

A

on suspicion
don’t wait for confirmation

24
Q

what action can public health take

A

contract tracing

chemoprophylaxis

vaccination

alerting and informing close contacts and the public

25
Q

define confirmed case for public health purposes

A

clinical diagnoses with lab confirmation (immediate pH action)

26
Q

define probable case for public health purposes

A

clinical case with no lab confirmation, but meningococcal disease is most likely (immediate PH action)

27
Q

define possible case for public health purposes

A

no lab confirmation and other diagnoses is equally likely (no immediate PH action)

28
Q

define close contacts

A
  • people living in the same household as the case
  • anyone who slept overnight in the same household in previous 7 days
  • other household members if case stayed overnight elsewhere in previous 7 days
  • intimate kissing contacts in lass 7 days
29
Q

what type of antibiotics is given

A

chemoprophylaxis

30
Q

why are antibiotics given for meningitis s

A

to eradicate throat carriage

31
Q

main type of antibiotic given

A

ciprofloxacin

single dose
doesn’t interact well with oral contraceptives
readily available

32
Q

alternative antibiotic given

A

rifampicin

33
Q

what happens if there is delayed report of a case

A

offer prophylaxis to household contacts up to 4 weeks after case became ill

34
Q

what do you give for meningococcal conjunctivitis

A

prophylaxis

35
Q

further public health actions

A

Contact school/nursery/university etc
Standard letter to warn and inform
Customised letter if unusual circumstances e.g. death
Offer leaflets
Offer information/support/helpline
Media handling

36
Q

do we get cluster cases in this country

A

no its rare less than 5%
most cases are individual

37
Q

what age range is most popular

A

teenagers / youths

outbreaks occur in schools/colleges

38
Q

what does action depend on

A

attack rate
isolation of the same organism
establishing a link between cases
public anxiety

39
Q

describe clusters in schools

A

Two probable or confirmed cases of the same type within 4 weeks

Need to define the risk group
Class, Year group, or Whole school

40
Q

describe clusters in the community

A

Look for links
Define an at risk population
Calculate age-specific attack rates Loading…
No specific threshold, but look for a substantial increase

41
Q

describe global epidemiology

A

Occurs sporadically, and in small clusters worldwide

Seasonal variation: October-May in Northern

Hemisphere Groups B&C most common in Europe and Americas

Group A most common in Africa and Asia

42
Q

causes of epidemic meningitis s

A

• Dry season (Dec – Jun) dust laden winds
• Upper Respiratory Tract Infection (URTI) due to cold nights
• Decrease in “local immunity” in pharynx
• Overcrowded housing
• Large population displacements due to pilgrimages and traditional markets
• Herd immunity leads to cyclical epidemics

43
Q

3 goals of WHO to defeat meningitis by 2030

A

Elimination of bacterial meningitis epidemics

Reduction of cases of vaccine-preventable bacterial meningitis by 50% and deaths by 70%

Reduction of disability and improvement of quality of life after meningitis due to any cause

44
Q

4 types of vaccines for meningococcal

A

MenC conjugate vaccine

Hib/MenC conjugate vaccine

MenACWY quadrivalent conjugate vaccine

multi component protein vaccine (MenB)

45
Q

immunisation schedule for meningococcal routine vaccination

A

8 weeks
16 weeks
one year
14 years

46
Q

describe polysaccharide vaccines

A
  • Polysaccharide vaccines give only short term (3-5 years) protection
    • Polysaccharide vaccines will not evoke an immune response in children under 2 years
47
Q

describe conjugate vaccines

A

Polysaccharide-conjugate vaccines are immunogenic across all ages. In infants and young children, conjugation increases the immunogenicity of the vaccines compared to polysaccharide only vaccines
• also prevents acquisition of carriage so interrupt transmission of meningococci to others and induces population protection
• Serogroup specific and do not provide any cross-protection against other meningococcal serogroups

48
Q

describe meningitis B vaccine

A

Biologically difficult to produce. Antigenically similar to brain protein.
• In UK, multiple strains of serogroup B, so not easy to produce a “one size fits all” vaccine.
• Group B vaccine developed, given routinely for infants, but issues with uncertain effectiveness and high costs
• Not used in outbreaks
38

intro to clinical sciences phase 2 (48 decks)

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