1. Meningococcal infection (А 39)
Infectio meningococcica

2. Acute infection of respiratory tract, which is caused by meningococcous (Neisseria meningitidis) and clinically represents in the forms of nasopharyngitis, sepsis or meningitis

3. Etiology Neisseria meningitidis Gramnegative diplococcus (0,6-1,0 mkm)
Intracellular location in the blood smear, combined in pairs, cofee-grains-like
A, B, C, D, X, Y, Z serotypes of infectious agents

4. Neisseria meningitidis

5. The source of disease: patients with meningococcal nasopharyngitis
carriers (1 case per 2000 carriers)
patients with meningococcal nasopharyngitis
patients with generalized forms of infection

6. Mechanism of transmission – air-drop
Seasonal occurrence – February-April
Most of the patients are children under 10
Morbidity is sporadic, sometimes epidemic
Immunity is type-specific, steady

7. Pathogenesis Entrance gate - upper respiratory routes
Local inflammatory process (nasopharyngitis)
Overcoming of a protective barrier (meningococcaemia)
Penetration of the agent through hematoencephalitic barrier, irritation of receptors of soft cerebral membrane of the brain and systems, forming cerebrospinal fluid
Hypersecretion of cerebrospinal fluid
Disorders of circulation of the blood in the brain vessels and membranes, delay of resorbtion of cerebrospinal fluid
Swelling-edema of the brain hyperirritation of the brain’s membranes and radices of cerebrospinal nerves
Production of endotoxin, damage of endothelium of the vessels (capillary toxicosis, hemorrhagic symptoms, IDS, ITS)

8. Anatomic pathology changes

10. Classification: I. Primarily localized forms:
- meningococcal carrier state;
- acute nasopharyngitis;
II. Hematogenic generalized forms:
- meningococcemia;
- meningitis;
- meningoencephalitis;
III. Mixed forms (meningococcemia+meningitis);
IV. Rare forms (endocarditis, arthritis, irideocyclitis, pneumonia).
Complications: severe brain edema, infectious-toxic shock

11. Rashes peculiarities:
haemorrhagic;
localization on buttocks, thighs, shins, trunk;
a lot of elements;
different sizes of elements – from patechial to the spread hemorrhages;
non correct form, often star-like;
different coloring and brightness of elements;
necrosis in place of considerable hemorrhages with formation of defects;
often combination of hemorrhages with roseolla and papules.

16. Haemorrhagic scleritis in case of meningococcemia

17. Typical position of patient with meningococal infection

18. Symptom
Meningococal meningitis
Second festering meningitis
Serous (viral) meningitis
Toubercoulous meningitis
Beginning
Sudden
Acute
Acute, rarer gradual
Gradual, rarer subacute
Fever
High
Of Long Duration
Headache
Very severe
It Is Expressed
Severe at the beginning of illness
It is acute expressed, attack like in half of patients
Vomits
Often, without nausea
Often
Often, at the beginning of disease
Rarely, gradually becomes more frequent
Rigidity of muscles of the back of head
Moderate
Grows gradually
Symptom Kernic
It is expressed at the beginning of illness
Grows gradually, expressed anymore than rigidity of muscles of the back of head

19. Laboratory diagnostics
1. Revealing of infectious agent in smears from pharynx, blood, liquor
- the material for stain should be taken without touching of mucous membrane of cheeks and tongue.
Microscopy: gram-negative diplococci with intracellular localization
2. Serologic tests: in dynamic with interval 5-7 days
3. Express-diagnosis: immunofluorescent method.

20. Liquor in case of meningococcal meningitis

21. Treatment Generalized forms: immediate hospitalization
antibiotics in large doses (benzylpenicilline – U/kg, levomycetini succinatis)
corticosteroids
dehydratation therapy (in case of meningitis)
desintoxication
treatment of disseminated intravessel coagulation (heparin, contrical, human plasma)
Sanation of meningococcus carriers:
antibiotics in common doses (ampicillini, levomycetini, rifampicini)
local sanation (ultraviolet, ultrasonic)
desensibilisation therapy

22. Antiepidemic measures against the source of infection:
- revealing of patients with meningococcal meningitis and sepsis and their hospitalization;
- patients with meningococcal nasopharyngitis should be hospitalize in infectious hospital or isolate at home;
- isolation of patients till their clinical convalescence and negative bacteriological investigation;

23. Ant epidemic measures
contact persons should be observed during 10 days with their thermometry every day, skin and throat examination and bacteriological test
persons with rash and inflammatory changes in the throat should be isolated and observed
in child's institutions apply 10-days quarantine
sanation of carriers by antibiotics (ampicillin, erythromycin) and discharging after double bacteriological investigation.