Meningococcal disease describes an infection caused by the bacterium Neisseria meningitidis (also called meningococcus). This carries a high mortality rate if left untreated but is a vaccine-preventable disease. Although best known for causing meningitis, a spreading blood infection can cause sepsis, which is a more destructive and dangerous condition. Meningitis and meningococcemia are major causes of illness, death, and disability in developed and underdeveloped countries.
There are about 2,600 cases of bacterial meningitis per year in the United States, and an average of 333,000 cases in developing countries. The case mortality rate is between 10 and 20 percent. The incidence of endemic meningococcal disease over the past 13 years ranges from 1 to 5 per 100,000 in developed countries, and from 10 to 25 per 100,000 in developing countries. During the epidemic, the incidence of meningococcal disease reached 100 per 100,000. Meningococcal vaccine has sharply reduced the incidence of disease in developed countries.
The pathogenesis of this disease is not fully understood. These pathogens colonize large numbers of the general population without harm, but in some very small percentage of the individuals it can attack the bloodstream, and the whole body but most of the limbs and the brain, causing serious illness. Over the past few years, experts have made intensive efforts to understand specific aspects of meningococcal biology and host interaction; however, the development of better care and effective vaccines is expected to depend on new efforts by workers in various fields.
While meningococcal disease is not contagious like the common cold (which spreads through ordinary contact), the disease can be transmitted through saliva and sometimes through close and prolonged general contact with an infected person.
Video Meningococcal disease
Signs and symptoms
Meningococcemia
Meningococcemia, like many other gram negative blood infections, can cause disseminated intravascular coagulation (DIC), which is an improper blood clot in the vessels. DIC can cause ischemic tissue damage when the upstream thrombi blocks the blood flow and bleeding because the clotting factor is exhausted. Small bleeding to the skin causes a typical petechia rash, which comes with a star-like shape. This is because the release of toxins into the blood that breaks the walls of blood vessels. The rash may develop under the skin because of a blood leak that can leave red or brownish spots, which can develop into a purple bruise. A meningococcal rash can usually be confirmed by a glass test where the rash does not fade under pressure.
Meningitis
Meningococcal meningitis is a form of bacterial meningitis. Meningitis is a disease caused by inflammation and irritation of the meninges, the membranes that surround the brain and spinal cord. In meningococcal meningitis, it is caused by bacteria that attack the cerebrospinal fluid, which circulates through the central nervous system. Sub-Saharan Africa, America, Western Europe, England, and Ireland still face many challenges against this disease, 200 years after the discovery of bacterial meningitis.
Other types
Just like the gram negative bacteria, N. meningitidis can infect various sites.
Meningococcal pneumonia can occur during influenza pandemic and in military camps. These are multilobar, fast-growing pneumonia, sometimes associated with septic shock. With fast treatment, the prognosis is remarkable. Another alternative is dexamethasone with vancomycin and meropenem. Pericarditis may appear, either as septic pericarditis with a cemetery prognosis or as a reactive pericarditis in the wake of meningitis or septicemia.
Myocarditis can be a complication of meningococcemia and may contribute to the shock seen in this disease. Pharyngitis and conjunctivitis may also appear and may be the incoming portal for bacteria. Septic arthritis because N. meningitidis can be seen, usually with disseminated infection. Other forms of disease are rarely seen, such as osteomyelitis, endophthalmitis and urethritis.
Maps Meningococcal disease
Pathogenesis
Meningococcal disease causes life-threatening meningitis and sepsis conditions. In the case of meningitis, bacteria attack the lining between the brain and the skull called the meninges. The infected fluid from the meninges then enters the spinal cord, causing symptoms including stiff neck, fever and rash. Meninges (and sometimes the brain itself) begin to swell, which affects the central nervous system.
Even with antibiotics, about 1 in 10 meningococcal meningitis victims will die; However, as many survivors of the disease lose their limbs or hearing, or suffer permanent brain damage. This type of sepsis infection is much more deadly, and causes severe blood poisoning called meningococcal sepsis that attacks the whole body. In this case, bacterial toxins rupture blood vessels and can quickly kill vital organs. Within a few hours, the patient's health may change from seemingly good to the severely ill.
The N. meningitidis bacteria is surrounded by a slimy outer layer that contains the disease-causing endotoxin. While many bacteria produce endotoxin, the rate produced by meningococcal bacteria is 100 to 1,000 times greater (and therefore more lethal) than normal. When the bacteria breed and move through the bloodstream, it discards some concentrated toxins. Endotoxin directly affects the heart, reduces its ability to circulate blood, and also causes pressure on blood vessels throughout the body. When some blood vessels begin to bleed, the major organs such as the lungs and kidneys are damaged.
Patients suffering from meningococcal disease are treated with large doses of antibiotics. Systemic antibiotics that flow through the bloodstream quickly kill bacteria but, because the bacteria are killed, even more toxins are released. It may take up to several days for the toxin to be neutralized from the body using fluid treatment and continuous antibiotic therapy.
Meningitis
Patients with meningococcal meningitis usually present with high fever, nuchal stiffness (neck stiffness), Kernig marks, severe headache, vomiting, purpura, photophobia, and sometimes chills, changes in mental status, or seizures. Diarrhea or respiratory symptoms are less common. Petechies are often present, but not always, so their absence should not be used against the diagnosis of meningococcal disease. Anyone with symptoms of meningococcal meningitis should receive intravenous antibiotics before lumbar puncture results, because delay in treatment worsens prognosis.
Meningococcemia
The symptoms of meningococcemia, at least initially, are similar to influenza. Usually, the first symptoms include fever, nausea, myalgia, headache, arthralgia, chills, diarrhea, stiff neck, and malaise. Subsequent symptoms include septic shock, purpura, hypotension, cyanosis, petechiae, seizures, anxiety, and multiple organ dysfunction syndrome. Acute respiratory distress syndrome and mental status changes may also occur. Petichial rash comes with a 'star-like' shape. Meningococcal sepsis has a greater mortality rate than meningococcal meningitis, but the risk of neurologic residual symptoms is much lower.
Prevention
The most important form of prevention is the vaccine against N. meningitidis . Different countries have different bacterial strains and therefore use different vaccines. Twelve serogroups (strains) exist with six potentially leading to major epidemics - A, B, C, X, Y and W135 responsible for almost all cases of disease in humans. Vaccines are currently available for all six strains, including the latest vaccine against serogroup B. The first vaccine to prevent meningococcal serogroup B (meningitis B) has been approved by the European Commission on January 22, 2013. The vaccine is manufactured by Novartis and sold under the tradename Bexsero. Bexsero is used for all age groups of two months and older.
Menveo vaccine Novartis Menactra, Menomune from Sanofi-Aventis, Mencevax from GlaxoSmithKline and NmVac4-A/C/Y/W-135 (not yet licensed in the US) from JN-International Medical Corporation are commonly used vaccines. The vaccine offers significant protection from three to five years (Menomune, Mencevax and NmVac-4) vaccines for up to eight years (Menactra conjugate vaccine).
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm431370.htm
Vaccinations
Children
Children aged 2-10 years who are at high risk for meningococcal disease such as certain chronic medical conditions and traveling to or living in countries with hyperemic or epidemic meningococcal disease should receive primary immunization. Although the safety and efficacy of the vaccine has not been established in children younger than 2 years and under epidemic control, the unconjugated vaccine may be considered.
Teen
It is recommended that primary immunization against meningococcal disease with meningitis A, C, Y and W-135 vaccine for all young adolescents at age 11-12 years and all unvaccinated teenagers at age 15 years. Although conjugate vaccines are the preferred meningococcal vaccine in adolescents aged 11 years or older, polysaccharide vaccines are an acceptable alternative if conjugated vaccines are not available.
Adult
Students planning to stay in dorms receive primary immunization with meningitis A, C, Y and W-135 vaccines, although the risk for meningococcal disease for 18-24 year-olds is similar to that of the general population of the same age. College students consider vaccinations against meningococcal disease to reduce their risk for disease and state that college health care providers should take a proactive role in providing information about meningococcal disease to students and their parents.
Routine primary immunization against meningococcal disease is recommended for most adults living in endemic areas or planning to travel to the area. Although conjugate vaccine is the preferred meningococcal vaccine in adults 55 years or younger, polysaccharide vaccine is an acceptable alternative for adults in this age group if a conjugated vaccine is not available. Because the safety and efficacy of conjugate vaccines in adults older than 55 years have not been established to date, polysaccharide vaccines should be used for primary immunization in this group.
Medical staff
Health care people should receive routine immunization against meningococcal disease for laboratory personnel who are routinely exposed to the isolate of N. meningitidis . Laboratory staff and medical staff are at risk of exposure to N. meningitides or patients with meningococcal disease. Recommendation of the Hospital Infection Control Advisory Committee (HICPAC) recommendations on immunization of health workers that routine health care personnel vaccinations are recommended. Every individual aged 11-55 years who wishes to reduce the risk of meningococcal disease may receive meningitis A, C, Y and W-135 vaccines and those older than 55 years. In certain circumstances if unvaccinated health care personnel can not be vaccinated and who have intensive contact with oropharynx secretions from infected patients and who do not take appropriate precautions should receive anti-infective prophylaxis against meningococcal infection (ie, 2-day oral rifampicin regimen or a single dose of ceftriaxone IM or a single dose of oral ciprofloxacin).
Recruiting US Military
Because the risk of meningococcal disease increases among US military recruits, all military members routinely receive primary immunization against the disease.
Tourists
Immunization against meningococcal disease is not a requirement for entry into any country, unlike Yellow fever. Only Saudi Arabia requires travelers to their countries to make annual pilgrimage Hajj and Umrah have vaccinated certificates against meningococcal disease issued no later than 3 years and no less than 10 days before arrival in Saudi Arabia.
Tourists or residents of areas where N. meningitidis are highly endemic or epidemic at risk of exposure should receive primary immunization against meningococcal disease.
Individuals infected with HIV
People infected with HIV tend to be at high risk for meningococcal disease; People infected with HIV who wish to reduce the risk of meningococcal disease may receive primary immunization against meningococcal disease. Although the efficacy of meningitis A, C, Y and W-135 vaccines has not been evaluated in people infected with HIV to date, HIV-infected individuals aged 11-55 years may receive primary immunization with conjugated vaccines. Vaccination against meningitis does not decrease CD4 T-cell counts or increase viral load in HIV-infected individuals, and there is no evidence that vaccines affect survival negatively.
Close contact
The protective level of anticapsular antibodies is not reached until 7-14 days after the administration of the meningococcal vaccine, vaccination can not prevent early onset disease in this contact and is usually not advisable to follow sporadic cases of invasive meningococcal disease. Unlike developed countries, in sub-Saharan Africa and other developed countries, the whole family lives in one-room homes.
Meningococcal infections are usually inserted into the household by an asymptomatic person. Transportation then spreads through the household, reaching the infant usually after one or more other household members have been infected. The disease is most likely to occur in infants and young children who have no immunity to circulating organism strains and which then acquire invasive strain strains.
By preventing susceptible contact from acquiring infection by directly inhibiting colonization. Close contact is defined as those who may have intimate contact with the patient's oral fluids such as through kissing or sharing food or drink. The importance of carriers of meningococcal disease is well known. In developed countries disease transmission usually occurs in child care, schools and large gatherings where usually transmission of disease can occur. Since the meningococcal organism is transmitted by respiratory droplets and susceptible to drying, it has been postulated that close contact is necessary for transmission. Therefore, transmission of the disease to other vulnerable people can not be prevented. Meningitis occurs sporadically throughout the year, and since the organism has no known reservoir outside the human, an asymptomatic carrier is usually a source of transmission.
In addition, basic hygiene measures, such as washing hands and not sharing a drinking cup, can reduce the incidence of infection by limiting exposure. When a case is confirmed, all close contact with an infected person can be offered antibiotics to reduce the chance of infection spreading to others. However, rifampic-resistant strains have been reported and inappropriate use of antibiotics contributes to this problem. Chemoprophylaxis is commonly used for close contacts that are at high risk of carrying a pathogen strain. Because the duration of the vaccine is unknown, bulk vaccination may be the most cost-effective way to control the transmission of meningococcal disease, rather than routine bulk vaccination schedules.
Chronic medical condition
People with component deficiencies in the general complementary pathway (C3, C5-C9) are more susceptible to N. meningitidis infection than satisfactory complement, and it is estimated that the risk of infection is 7000 times higher in that individual. In addition, populations with complementary component deficiency often experience meningococcal disease that often occurs because their immune responses to natural infections may be incomplete compared to complementing the non-deficient.
Inherited properdin deficiency is also associated, with an increased risk of contracting meningococcal disease. People with functional or anatomic asplenia may not efficiently clean up the encapsulation of Neisseria meningitidis of blood flow People with other conditions associated with immunosuppression may also be at higher risk of developing meningococcal disease.
Infectious disease control
Meningitis A, C, Y, and W-135 vaccines can be used for large-scale vaccination programs when meningococcal outbreaks occur in Africa and elsewhere in the world. Whenever a sporadic case or cluster or outbreak of meningococcal disease occurs in the US, chemoprophylaxis is the primary means of preventing secondary cases in households and other close contacts of individuals with invasive diseases. Meningitis A, C, Y, and W-135 vaccines can rarely be used in addition to chemoprophylaxis, but only in situations where there is a continuous risk of exposure (eg, when cluster or epidemic cases occur) and when the serogroups contained in the vaccine involved.
It is important that physicians promptly report all suspected or confirmed cases of meningococcal disease to local public health authorities and that the serogroup of involved meningococcal strains is identified. The effectiveness of bulk vaccination programs depends on early and accurate introduction of the outbreak. When the alleged outbreak of meningococcal disease occurs, public health authorities will then determine whether mass vaccination (with or without mass chemoprophylaxis) is indicated and describes the target population to be vaccinated based on risk assessment.
Treatment and prognosis
When meningococcal disease is suspected, treatment should begin immediately and should not be delayed pending investigation. Treatment in primary care usually involves giving intramuscular benzylpenicillin, and then an urgent transfer to the hospital (hopefully, my academic-level medical center, or at least hospitals with neurological care at all times, ideally with neurological and intensive care units) for further treatment. Once in the hospital, antibiotics of choice are usually IV broad spectrum of 3rd generation cephalosporins, for example, cefotaxime or ceftriaxone. Benzylpenicillin and chloramphenicol are also effective. Supportive measures include IV fluids, oxygen, inotropic support, eg, dopamine or dobutamine and increased intracranial pressure management. Steroid therapy may be helpful in some adult patients, but it is unlikely to affect long-term outcomes.
Complications after meningococcal disease can be divided into groups of early and late. Early complications include: increased intracranial pressure, disseminated intravascular coagulation, seizures, circulatory collapse and organ failure. The next complications are: deafness, blindness, long-standing neurological deficits, decreased IQ, and gangrene leading to amputation.
Epidemiology
Africa
The importance of meningitis is as important in Africa as HIV, TB and malaria. The case of meningococcemia that leads to severe meningoencephalitis is common among children and the elderly. Deaths occurring in less than 24 hours are more likely during epidemic epidemic diseases in Africa and Sub-Saharan Africa are plagued by epidemic meningitis epidemics. Perhaps climate change contributes significantly to the spread of disease in Benin, Burkina Faso, Cameroon, Central African Republic, Chad, CÃÆ'Â'te d'Ivoire, Democratic Republic of Congo, Ethiopia, Ghana, Mali, Niger, Nigeria and Togo. This is an area of ​​Africa where the disease is endemic: meningitis is "secretly" present, and there are always some cases. When the number of cases passes five per 100,000 population in a week, the team is on alert. The epidemic rate was reached when there were 100 cases per 100,000 population for several weeks.
A more complicated effort to stop the spread of meningitis in Africa is the fact that the extremely dry and dusty weather conditions that characterize Niger and Burkina Faso from December to June support the development of the epidemic. The overcrowded village is a breeding ground for bacterial transmission and causes a high prevalence of respiratory infections, which makes the body more susceptible to infection, encouraging the spread of meningitis. IRIN Africa news has provided the number of deaths for each country since 1995, and mass vaccination campaigns after the outbreak of the meningococcal disease community in Florida were conducted by the CDC.
History and etymology
From the Greek meninx (membrane) kokkos (berry), meningococcal disease was first described by Gaspard Vieusseux during the outbreak in Geneva in 1805. In 1884, the Italian pathologist Ettore Marchiafava and Angelo Celli described intracellular micrococci in cerebrospinal fluid, and in 1887, Anton Wiechselbaum identified meningococcus (expressed as Diplococcus intracellularis meningitidis ) in cerebrospinal fluid and formed a link between organism and epidemic meningitis.
See also
- Endocarditis
- Pathogenic bacteria
- Waterhouse-Friderichsen Syndrome
- African meningitis belt
- 2009-10 Western African meningitis epidemic
- Meningococcal vaccine
- Meningitis Vaccine Project
References
External links
- DermAtlas -1886809878
- www.meningococcal.com.au
- Centers for Disease Control and Prevention (2012). "Ch 13: Meningococcal Disease". At Atkinson W, Wolfe S, Hamborsky J. Epidemiology and Prevention of Vaccine-Preventable Diseases (12th ed.). Washington DC: Community Health Foundation. pp. 193-204. Archived from the original on March 10, 2017.
- The Meningitis Research Foundation
Source of the article : Wikipedia
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