1. EPIDEMIC CEREBROSPINAL MENINGITIS
Dept. Of Infectious Disease
Shengjing Hospital

2. DEFINITION
1. Epidemic cerebrospinal meningitis is acute infectious disease caused by
meningococcus.
2.characteristics of ECM are fever,
headache, vomiting , petechiae or ecchymosis , and meningeal irritation signs. CSF is purulent .

3. ETIOLOGY
1.Pathogen is Neisseria meningitidis (meningococcus); G diplococcus.
2.Biological features:
2.1.The organism grow by incubation
on blood,chocolate or trypticase soy agar in 5~10%CO2,PH 7.4~7.6;
2.2.The organism is susceptible to dry,
heat , chill and disinfectant;

5. ETIOLOGY 2.3. autolysis by autolysin in vitro;
3.The organism can be detected in patient’s nasopharynx, blood, CSF, petechiae in skin;
4.Pathogenic factor: endotoxin.

6. ETIOLOGY 5.Serogroups of meningoccus;
13 serogroups and more than serotypes found in the world;
most common serogroups:
A B C group
Group A is the most common in china.

7. EPIDEMIOLOGY 1.Source of infection: patients and carriers;
2.The routes of transmission :
1) air borne
2) closed contact transmission :
3.Susceptibility of population: universal susceptible
stable and persistent immunity

8. EPIDEMIOLOGY 4.Epidemiologic feature: (1). Season: November - May
high peak: March - April
(2).age: 6 months to 2 years old

9. PATHOGENESIS meningococci extinguished nasopharynx carriers 60 - 70%
upper respiratory tract
infection %
meningococcemia period
septicemia
pyogenic meningitis 1%

10. Fulminant type
endotoxin
microcirculatory failure DIC
contraction of brain vessel
brain edema
shock bleeding coma

11. PATHOLOGY Septicemic stage: 1. vascular endothelial injury;
2. vascular wall inflammation,necrosis,
3. thrombosis, perivascular bleeding
Meningitis stage:
1. Site : leptomeninx , arachnoid
2. congestion, bleeding, swelling of meningeal vessel,

12. PATHOLOGY
3. Exudation of fibroprotein , neutrophil and plasma ( CSF is purulent)
4. cranial nerves is injured.
Fulminant meningoencephlitis type
congestion, bleeding, necrosis and
swelling of brain tissue.
intracranial hypertension
brain hernia

13. CLINICAL MANIFESTATION
Incubation period: 1~10 days(2~3days)
common type:
1.URT infectious stage:
2.septicemic stage:
toxemia symptoms;
petechiae, purpura or ecchymosis.
3.meningitis stage:
3.1.High fever and septicemic symptoms;

17. CLINICAL MANIFESTATION
3.2.CNS symptoms:headache,vomiting,
meningeal irritation:
nuchal rigidity;Kerning’signs and
Brudzinski’signs are positive.
severe case :drowsiness,delirium, and restless merge into coma.
Convulsions may occur at any stage
of the illness.
4.Convalescent stage:5~7days from

18. CLINICAL MANIFESTATION
Fulminant types: forms:
1.shock form:the most dramatic form;
1.1.severe toxic symptoms;
1.2.wildly petechiae, purpura, ecchymosis
1.3.shock :pallor,extremities cold, cyanosis, hypotension, pales quickly
1.4.DIC;
1.5.MOF;

19. CLINICAL MANIFESTATION
1.6.Meningeal irritant signs is absent,
CSF is normal;
1.7.Blood Culture of meningococcus.
2 . Meningoencephalitis type:
2 .1.fever,toxic symptoms,petechiae;
2 .2.repeated convulsions
2 .3.Intracranial hypertension:

20. CLINICAL MANIFESTATION
Severe headache;projectile vomiting;
Papillar edema;encephalocele;
respiratory failure.
3.mixed type:
The mild form:
The chronic meningococcemia form:

21. Complications Otitis media,purulent arthritis,
endocarditis,pericarditis,pneumonia or
panophthalmitis.
Sequelae:
hydro-subdura, hydrocephalus, cranial nerves injured,deafness,
blindness,paralysis etc.

22. DIAGNOSIS 1.Epidemiologic data: 2 .Clinical manifestations:
3 .Lab findings;

23. Laboratory Findings:
1.Blood pictures: WBC20x109,PLT is decrease in DIC;
2.CSF is suppurative;
3.Bacteriologic diagnosis:smear or
culture;
4.Immunologic test:antigen and antibody

24. DIFFERENTIAL DIAGNOSIS
1.Other purulent meningitis;
2 .TB MENINGITIS;
3.Epidemic encephalitis B;
4.Septicemia.

25. TREATMENT COMMON TYPE: 1.General treatment: 2 .Pathogenic treatment :
2 .1.penicillin G:
2 .2 .Chloramycin:
2 .3.Ceftriaxone,Cefotaxime;
3.symptomatic therapy:

26. FULMINANT TYPE 1.SHOCK form: 1.pathogenic therapy; 2 .Anti-shock;
3. Steroid;hydrocoticosterone etc;
4. Anti-DIC;
5. Protect major organs;

27. 2 .Meningoencephalitis:
1. Antibiotics;
2 .Decrease intracranial hypertension;
3 .Steroid;
4. Anti-respiratory failure;
5. Symptomatic treatment;

28. PREVENTION 1.Isolation source of infection;
2.Cut the route of transmission;
3 .Protect susceptible population:
3.1.Chemoprophylaxis:
SMZ CO or rifampicin;
3. 2 .Vaccination.