20221 - MENINGOCOCCAL MENINGITIS (MCM) AT NEW DELHI &...

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Unformatted text preview: MENINGOCOCCAL MENINGITIS (MCM) AT NEW DELHI & INDIA Dr. A. K. AVASARALA MBBS, M.D. PROFESSOR & HEAD DEPT OF COMMUNITY MEDICINE & EPIDEMIOLOGY PRATHIMA INSTITUTE OF MEDICAL SCIENCES, KARIMNAGAR, A.P. INDIA: +91505417 [email protected] PART-II CLINICAL DISEASE, EPIDEMIOLOGY AND CONTROL DEFINITION IT IS A PYOGENIC INFECTION OF MEMBRANES COVERING THE BRAIN AND SPINAL CORD ( DURA, PIA AND ARACNOID MEMBRANES) BY MENIINGO-COCCI ALSO CALLED CEREBROSPINAL FEVER CLINICAL PRESENTATIONS RESTRICTED TO NASOPHARYNX AS ASYMPTOMATIC CASES OR ONLY WITH LOCAL SYMPTOMS INVASIVE WITH ACUTELY ILL SEPTICEMIC AND TOXIC MENINGEAL CLINICAL PICTURE IN THE NEWBORN MINIMAL AND VARIABLE, HENCE DIAGNOSIS DIFFICULT SLUGGISH, LETHARGIC WITH UNUSUAL GAZE DOES NOT TAKE FEED WELL , MAY VOMIT HIGH PITCHED CRY AND CONVULSIONS HYPOTHERMIA SEEN USUALLY, FEVER MAY BE THERE TENSE AND BULGING ANTERIOR FONTANELLAE VERY USUAL CLINICAL PICTURE IN PRESCHOOL & SCHOOL CHILD WIDE SPECTRUM OF SIGNS & SYMPTOMS IN THIS AGE GROUP AND MORE OBVIOUS MODERATE TO HIGH FEVER HEADACHE, VOMITING, PHOTOPHOBIA, CONVULSIONS, NECK STIFFNESS, NEUROLOGICAL IRRITATION SKIN RASHES CLINICAL PICTURE IN < 2 YEAR OLD CLASSICAL SIGNS MAY NOT BE PRESENT BUT HIGH DEGREE OF SUSPICION WHEN THE FOLLOWING PICTURE IS SEEN FEVER COMMON MACULOPAPULAR PETECHIAL RASH IN HALF OF THE CASES REFUSAL OF FEEDS VOMITINGS, ALTERED SENSORIUM IRRITABILITY BULGING FONTANELLAE NEUROLOGICAL DEFICIT (EITHER MONOPLEGIA, HEMIPLEGIA AND SQUINT CLINICAL PICTURE IN THE ADULT CLEARCUT PICTURE FEVER, INTENSE HEADACHE VOMITING, PHOTOPHOBIA, NECKPAIN AND STIFFNESS SIGNS OF MENINGEAL IRRITATION AND ALTERED SENSORIUM SKIN RASHES SIGNS AND SYMPTOMS OF SHOCK DIFFERENTIAL DIAGNOSIS IN NEONATE: SEPTICEMIA, GASTROENTERITIS, BIRTH HYPOXIA, BIRTH TRAUMA, RESPIRATORY INFECTIONS, HYPOGLYCEMIA, METABOLIC DISORDERS CAUSING CONVULSIONS AND KERNICTERUS IN OLDER CHILDREN AND ADULTS: ENCEPHALITIS, BRAIN ABSCESS, CEREBRAL MALARIA, ASEPTIC MENINGITIS, CARDIOVASCULAR ACCIDENTS, CRYPTOCOCCAL MENINGIT IS AND TUBERCULAR MENINGITIS DIAGNOSIS MENINGOCOCCI ARE DEMONSTRATED BY LUMBAR PUNCTURE AND EXAMINATION OF CEREBRO SPINAL FLUID (CSF) & CULTURE OF CSF BLOOD CULTURE CULTURE FROM NASOPHARYNX EXAMINATION OF PETECHIAL SKIN LESIONS IMMUNOLOGICAL METHODS FOR ANTIBODIES (IFP, ELISA, CIEP) TREATMENT ISOLATION OR SEPARATION ALL PATIENTS NEED HOSPITALIZATION SPECIFIC TREATMENT - FLUIDS - CEFTRIAXONE/CEFOTOXIME - AMPICILLIN ( NOT TO BE GIVEN IF HYPERSENSITIVE TO PENICILLIN) - CHLORAMPHENICOL SUPPORTIVE THERAPY: FOR SHOCK AND CONVULSIONS EPIDEMIOLOGICAL INTERACTION AGENT FACTORS TIME DISRIBUTION MCM HOST FACTORS ENVIRONMENT FACTORS PLACE DISTRIBUTION PERSON DISTRIBUTION THE CAUSATIVE AGENT NEISSERIA MENINGITIDIS (MENINGO COCCUS) BISCUIT SHAPED GRAM + VE DIPLOCOCCUS SIZE & SHAPE VARIATION IN OLDER CULTURES DUE TO AUTOLYSIS TRANSPARENT ,NON PIGMENTED, NONHEMOLYTIC COLONIES 1-5 MM SIZE MENINGO COCCI SERO GROUP TYPING DEPEND UPON THE POLYSACCHARIDE CAPSULE NINE SEROLOGICAL GROUPS IDENTIFIED A, B, C, D, X , Y, Z , W-135, 29E ALL THE SEROGROUPS ARE PATHOGENIC BUT A, B, C, Y ARE MOST NEUROVIRULENT A AND C ARE MOST EPIDEMOGENIC MODE OF TRANSMISSION HUMAN CASES AND THE CARRIERS ARE THE ONLY RESERVOIRS TRANSMITTED BY DIRECT CONTACT (DROPLETS,DISCARGE FROM THE NOSE &THROAT OF THE PERSONS) INCUBATION PERIOD = 3-4 DAYS PERIOD OF COMMUNICABILITY IS AS LONG AS THE MENINGOCOOCI ARE PRESENT IN DISCARGES FROM NOSE, THROAT AND NASOPHARYNX PERSON FACTORS POOR NUTRITIONAL STATUS & IMMUNITY DRY NASAL MUCOSA PHYSICAL EXERTION FATIGUE CARRIER STATE AGE PREDILICTION PRIMARILY A CHILD DISEASE BUT CAN AFFECT YOUNG ADULTS ALSO SEX PREDILICTION MORE MALES ARE AFFECTED THAN FEMALES PLACE DISTRIBUTION MCM IS ENDEMIC IN LARGE TOWNS MCM IS ENDEMIC IN LARGE TOWNS MORE COMMONLY IN PEOPLE MORE COMMONLY IN PEOPLE LIVING IN CROWDED CONDITIONS TIME DISTRIBUTION GREATEST INCIDENCE IN WINTER AND SPRING CARRIER STATE TRANSMISSION OCCURS MORE OFTEN FROM CARRIERS RATHER THAN CASES BY AND LARGE HIGH CARRIER RATE IS USUALLY ASSOCIATED WITH OUTBREAKS CONTROL MEASURES COMPOSITION: 50 MICRO GRAMS OF "A" POLYSACHARIDE, 50 MICRO GRAMS OF "C" POLY SACHARIDE, 1 MG OF LACTOSE. DOSE - 0.5 ML OF IRRESPECTIVE OF AGE GIVEN SUBCUTANEOUSLY. EFFICACY SEROGROUP "A' CLINICAL EFFICACY = 85-95% SERO GROUP "A' INDUCES ANTIBODY RESPONSE IN CHILDREN AS YOUNG AS 3 MONTHS OLD. BUT SEROGROUP "C" DOES NOT INDUCE ANTIBODIES BEFORE 2 YEARS OF AGE. SEROGROUP "Y" AND W-135 ARE SAFE AND IMMUNOGENIC IN ADULTS AND CHILDREN ABOVE AGE OF 2 YEARS. VACCINATION VACCINATION LIMITATIONS 1. LIMITED SHELF LIFE AFTER REVACCINATION 1. NO VACCINE IS AVAILABLE AGAINST GROUP B 1. SHORT INCUBATION PERIOD visvis MORE TIME TAKEN FOR THE DEVELOPMENT OF IMMUNITY 1. 4.UNSATISFACTORY RESPONSE VACCINATION UNDER 2 YEARS OF AGE WHICH IS THE HIGHEST SUSCEPTIBLE AGEGROUP PRESENT STRATEGY FOR VACCINATION ONLY HIGH RISK PEOPLE (HEATH CARE WORKERS, TRAVELLERS, PEOPLE LIVING IN OVERCROWDED PLACES) AND CLOSE CONTACTS HAVE TO BE VACCINATED. VACCINATION FOR CONTACTS 1. FORTUNATELY, WE HAVE QUADRIVALENT VACCINES AT PRESENT 2. PROTECTION OCCURS ONLY AFTER 14 DAYS OF VACCINATION 3. HENCE CHEMOPROPHYLAXIS IS PROVIDED WITH ANTIBIOTICS IN THE MEANTIME VACCINATION FOLLOWED BY + CHEMOPROPHYLAXIS FOR CLOSE CONTACTS HOUSEHOLD MEMBERS DAY-CARE CENTRE CONTACTS ANYONE DIRECTLY EXPOSED TO THE PATIENT'S ORAL SECRETIONS OR RESPIRATORY DROPLETS. CHEMOPROPHYLAXIS FOR CLOSE CONTACTS WITHIN 24 HOURS FOR HOUSEHOLD WITH CONTACTS CLOSE CONTACTS CLOSE CONTACTS HIGH RISK PERSONS CIPROFLOXACIN, RIFAMPICIN, MINOCYCLINE, SPIRAMYCN, CEFTRIAXIONE RISK COMMUNICATION FOR ACTIVE AND SUSTAINED COMMUNITY PARTICIPATION TO CONTROL THE EPIDEMIC THROUGH PUBLIC EDUCATION REGARDING RISK FACTORS AND POSSIBLE CONTROL STRATEGIES NOTIFICATION OF CASES AT THE EARLIEST SURVEILLANCE PUBLIC EDUCATION AVOID OVERCROWDING. DO NOT SHARE DRINKING BOTTLES, GLASSES, CIGARETTES, LIPSTICKS OR OTHER ITEMS THAT MAY BE COVERED IN SALIVA. AVOID SMOKY AND DUSTY PLACES. TEACH CHILDREN NOT TO SHARE CUPS, SOFT DRINK CANS OR SPORTS WATER BOTTLES. ...
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This note was uploaded on 02/22/2012 for the course HIST 312 taught by Professor Staff during the Fall '10 term at Rutgers.

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