invasive meningococcal disease Flashcards
causes of meningitis.
bacteria:
- meningococcus
- pneumococcus
viruses:
- coxsackievirus
- echovirus
- herpes virus
- mumps virus
- influenza
- HIV
medications
cancers
autoimmune disease
what is invasive meningococcal disease?
- an infection with neisseria meningitidis
- gram-negative diplococci
- transmission by resp droplets / naso-pharyngeal secretions
2 manifestations:
- meningitis - localised infection of meninges with local symptoms
- septicaemia - systemic infection with widespread signs and generalised organ damage
meningococcal disease risk factors.
- 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
name the meningococcal meningitis symptoms.
- fever
- confusison
- stiff neck
- increased sensitivity to light
- headache
- nausea and vomitting
- slow and inactive
- irritable
- bulging anterior fontanelle
- in children non-blanching rash
name the meningococcal septicemia symptoms.
- 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)
explain the symptom purpura and DIC.
Sepsis can cause Disseminated Intravascular Coagulation (DIC) – the activation of coagulation pathways that results in formation of intravascular thrombi (clots) and depletion of platelets and coagulation factors.
These clots can cause arterial occlusions leading to gangrene of extremities & auto-amputations (spontaneous detachment of an appendage from the body)
when not treated, meningococcal diseases can have detromental effects and can esculate very quickly, name some things that can arise after.
- Deafness or partial hearing loss (34%),
- seizures (13%),
- motor deficits (12%),
- cognitive impairment (9%),
- blindness (6%),
- Amputations (8% of children, 3% of adults)
in order to diagnose meningococcal disease, what must be done?
- Blood sample for blood culture & PCR
- CSF for microscopy, culture and PCR
- for other local infections - aspiratae from sterile site for microscopy, culture and PCR
- throat swap for culture proves info
- additional samples required for enhanced national surveilance
name the methods of treatment including antibiotics given to close contacts of those with meningococcal disease. (the process of chemophylaxis)
Ciprofloxacin (recommended for all age groups and in pregnancy)
single dose
doesn’t interact with oral contraceptives
readily available
Rifampicin (alternative)
Delayed report of a case:
- offer prophylaxis to household contacts up to 4 weeks after case became ill
Prophylaxis for meningococcal conjunctivitis
Offer appropriate vaccine to unvaccinated close contacts (within a week)
what bacterium causes meningococcal disease?
Neisseria meningitidis
once someone is suspected of having meningococcal disease, what steps must be taken to prevent spread.
- identify UKHSA as its a notifiable disease
- contact tracing
- chemoprophylaxis (giving antibiotics to close contacts)
- vaccination
- alerting and informing close contacts and the public
what is identified as a close contact of someone with meningococcal disease?
- living in same household
- anyone slept overnight in same household in past 7 days
- if patient stayed in another household in past 7 days - those
- intimate kissing contacts in last 7 days
what is meant by a cluster and what factors depictates the action taken?
- Rare <5% cases occur in clusters
- Most common in teenagers/youths
- Outbreaks occur in schools/colleges
Action depends on:
- Attack rate
- Isolation of the same organism
- Establishing a link between cases
- Public anxiety
define clusters in schools.
Two probable or confirmed cases of the same type within 4 weeks
Need to define the risk group
Class,
Year group, or
Whole school
outline the different meningitis vaccine.
polysaccharide vaccine
- short term protection 3-5 years
- wont work in children under 2
conjugate vaccines
- works in all ages
- interrupts aquisation of being a carrier
- serogroup specific so dont provide protection against other meningococcal serogroups
meningitis B vaccine
- hard to produce
- because multiple straints of serogroup B, hard to make vaccine one size fits all
- routine for infants
- not used in outbreaks
