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phase 2a > Invasive Meningococcal Disease > Flashcards

Invasive Meningococcal Disease Flashcards

1
Q

what is meningitis?

A

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

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2
Q

what are the three layers of meninges?

A

dura mater
arachnoid mater
pia mater

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3
Q

what are the infectious causes of meningitis?

A

Bacteria e.g. meningococcus, pneumococcus

Viruses e.g. coxsackievirus, echovirus, herpes virus, mumps virus, influenza, HIV etc

Less common infective causes include fungi, protozoa, and other parasites

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4
Q

what are the non infectious causes of meningitis?

A

Medications e.g. antibiotics (amoxicillin, trimethoprim/sulfamethoxazole), carbamazepine, lamotrigine, NSAIDs, ranitidine

Cancers e.g. melanoma, lung cancer, breast cancer, lymphoma, leukaemia

Autoimmune disease e.g. Systemic lupus erythematosus (SLE), Behçet’s syndrome.

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5
Q

what are the causes of meningitis?

A

infectious - usually this is the cause
non infectious - rarer

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6
Q

why can diagnosing meningitis be difficult?

A

Diagnosis of acute bacterial meningitis can be challenging, as it can present with common, non-specific clinical features

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7
Q

what differential diagnosis could meningitis be confused with?

A

Viral meningitis
Fungal meningitis
TB meningitis
Drug-induced meningitis
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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8
Q

what is invasive meningococcal disease?

A

-Infection with Neisseria meningitidis
Gram-negative diplococci
Carried by 10-24% of the population
Humans are only known reservoir

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9
Q

how is invasive meningococcal disease transmitted?

A

Transmission by respiratory droplets/ naso-pharyngeal secretions
Transmitted by aerosol, droplets, or direct contact with secretions from the upper respiratory tract. Transmission usually requires either frequent or prolonged close contact

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10
Q

what is the incubation period of invasive meningococcal disease?

A

Incubation period 2-10 days, usually 3-4 days

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11
Q

what are the two main manifestations of invasive meningococcal disease?

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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12
Q

describe neisseria meningitides

A

12 serogroups based on the capsular polysaccharide

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13
Q

who does invasive meningococcal disease affect ?

A

-Commonly affects extremes of age (<2 months and >60 years) because of impaired or waning immunity.
- Another spike in incidence is also seen in adolescence and early adulthood (due to close contact/ social mixing?)

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14
Q

what are the 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

what are the symptoms of meningococcal meningitis?

A

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

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16
Q

what group of individuals may not have the usual symptoms of Meningococcal meningitis?

A

babies

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17
Q

what are the symptoms babies experience with meningococcal meningitis?

A

They may be:
-slow or inactive
-irritable
-vomiting
-feeding poorly
-or have a bulging anterior fontanelle (the soft spot of the skull)

18
Q

what Is a sign of Meningococcal meningitis in babies that drs can observe ?

A

brudzinkis neck sign
(google pic)

19
Q

what are the Meningococcal septicaemia symptoms?

A

Fever and chills
Fatigue
Vomiting
Cold hands and feet
Severe aches or pain in the muscles, joints, chest, or abdomen
Rapid breathing
Diarrhoea
Non blanching rash (petechiae)
In the later stages, a dark purple rash (purpura)

20
Q

how does Meningococcal septicaemia work?

A

The bacteria enter the bloodstream and multiply, damaging the walls of the blood vessels, causing bleeding into the skin and organs.

21
Q

what is a sign observed on the skin for Meningococcal septicaemia?

A

petechiae
a rash that when you pressed down on it, it doesn’t diseappear- can be hard to see on black or brown skin

22
Q

what can sepsis cause?

A

Sepsis can cause Disseminated Intravascular Coagulation (DIC)
These clots can cause arterial occlusions leading to gangrene of extremities & auto-amputations (spontaneous detachment of an appendage from the body)

23
Q

what is disseminated intravascular coagulation?

A

the activation of coagulation pathways that results in formation of intravascular thrombi (clots) and depletion of platelets and coagulation factors.

24
Q

what can disseminated intravascular coagulation cause

A

These clots can cause arterial occlusions leading to gangrene of extremities & auto-amputations (spontaneous detachment of an appendage from the body)

25
Q

what Is the natural history of the disease?

A
  1. acute onset- sudden or unanticipated development of disease
  2. fulminating infection- suddenly, escalated quickly and can be rapidly fatal
  3. prolonged and persistent coccaemia- bloodstream infection
26
Q

what long term complications can survivors have?

A

-Deafness or partial hearing loss (34%), seizures (13%), motor deficits (12%), cognitive impairment (9%), blindness (6%),
-Amputations (8% of children, 3% of adults)

27
Q

what do you need in order to make the diagnosis that should be collected on hospital admission?

A

-Blood sample for blood culture & PCR
-Cerebrospinal fluid (CSF) for microscopy, culture and PCR
-For other localised infections, aspirate from sterile site (e.g. joints) for microscopy, culture, PCR
-Throat swab for culture - provides important information about the infecting strain and should be submitted to the National Reference Laboratory for additional characterisation
-Additional samples required for enhanced national surveillance e.g. acute serum

28
Q

what law is there about notification?

A

Notifiable disease (Public Health Act, 1984)

29
Q

what diseases does the notifiable disease ( public health act, 1984) include?

A

Notify your regional UKHSA health protection team of
Meningitis (any cause)
Meningococcal septicaemia

30
Q

when would you notify according to the notifiable disease ( public health act, 1984)?

A

Notify on suspicion – don’t wait for laboratory confirmation as public health action needed ASAP to prevent further cases!
-Contact tracing
-Chemoprophylaxis
-(Vaccination)
-Alerting & informing close contacts & the public

31
Q

Chemoprophylaxis

A

Antibiotics given to eradicate throat carriage

32
Q

who is ciprofloxacin recommended for?

A

(recommended for all age groups and in pregnancy)

33
Q

benefits of ciprofloxacin?

A

single dose
doesn’t interact with oral contraceptives
readily available

34
Q

what’s an alternative for ciprofloxacin?

A

Rifampicin (alternative

35
Q

what does menC conjugate vaccine protect against?

A

meningococcal group C

36
Q

what does Hib/menC conjugate vaccine protect against?

A

Haemophilus influnzae type b/ meningococcal group C

37
Q

what does MenACWY quadrivalent conjugate vaccine protect against?

A

meningococcal groups A, c, W and Y

38
Q

what does multicomponent protein vaccine ( MenB)

A

meningococcal group B- may protect against other capsular groups

39
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

40
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

41
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

phase 2a (67 decks)

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