In 1887, Anton Weichselbaum, a Viennese doctor, was the first to report the
isolation of meningococci from patients with meningitis (1). Shortly after, came
the first description of lumbar puncture in living patients (2), leading to the isolation
of meningococci from acute cases of meningitis. Three years later, Kiefer
grew meningococci from the nasopharynx of cases of meningococcal disease,
and from their contacts (3), a finding of immense significance in advancing
understanding of the epidemiology and pathogenesis of the disease.
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Bench-to-bedside review: Genetic influences on meningococcal disease...
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Drotrecogin alfa (activated) in patients with severe sepsis presenting with purpura fulminans, meningitis, or meningococcal disease: a retrospective analysis of patients enrolled in recent clinical studies...
In the United States, the attack rate for sporadic meningococcal disease is ~1 case per 100,000 persons per year. Disease attack rates are highest among infants 3–9 months of age (10–15 cases per 100,000 infants per year). Attack rates are higher among children than among adults, and there is a second peak of incidence among teenagers, in whom outbreaks have often been tied to residence in barracks, dormitories, or other crowded conditions.
Outer-Membrane Components Associated with Virulence
Meningococcal strains are characterized by the expression of capsular polysaccharide and other outer-membrane structures, including LOS (endotoxin). Outer-membrane blebbing, meningococcal autolysis, molecular mimicry, genome plasticity, horizontal DNA exchange, and phase and/or antigenic variation are all important in meningococcal virulence.
Capsule The polysaccharide capsule is a major—if not the major—virulence factor of N. meningitidis.
Host Defense Mechanisms
Preventing meningococcal growth in blood requires bactericidal and opsonic antibodies, complement, and phagocytes (Fig. 136-3). The major bactericidal antibodies are IgM and IgG, which (except for serogroup B) bind to the capsular polysaccharide. Immunity to meningococci is therefore serogroup specific. Antibodies to other surface (subcapsular) antigens may confer crossserogroup protection. PorA, PorB, Opc, and LOS appear to be major targets of cross-reactivity and of serogroup B bactericidal antibodies.
Upper Respiratory Tract Infections Although many patients who develop meningococcal meningitis or meningococcemia report having had throat soreness or other upper respiratory symptoms during the preceding week, it is uncertain whether these symptoms are due to infection with meningococci. Meningococcal pharyngitis is rarely diagnosed. Adult patients with N. meningitidis bacteremia more often have clinically apparent disease of the respiratory tract (pneumonia, sinusitis, tracheobronchitis, conjunctivitis) than do younger patients.
Patients with meningococcal meningitis may develop cranial nerve palsies, cortical venous thrombophlebitis, and cerebral edema. Children may develop subdural effusions. Permanent sequelae can include mental retardation, deafness, and hemiparesis. The major long-term morbidity of fulminant meningococcemia is the loss of skin, limbs, or digits that results from ischemic necrosis and infarction.
Diagnosis Few clinical clues help the physician distinguish the patient with early meningococcal disease from patients with other acute systemic infections. ...
The attack rate for meningococcal disease among household or other close contacts of cases is 400-fold greater than that in the population as a whole. Close contacts of cases should receive chemoprophylaxis with rifampin, ciprofloxacin, ofloxacin, or azithromycin (Table 136-1). A single IM injection of ceftriaxone is also effective. Close contacts include persons who live in the same household, day-care center contacts, and anyone directly exposed to a patient's oral secretions. Casual contacts are not at increased risk.
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Improvements in the outcome of children with meningococcal disease...
Infectious diseases have been a problem for military personnel throughout history. The
consequences in previous conflicts have ranged from frequent illnesses disrupting daily activities
and readiness to widespread deaths. Preventive measures, early diagnosis, and treatment greatly
limit the exposures and acute illnesses of troops today in comparison with those in armies of the
past, but infections and consequent acute illnesses still occur. In addition, long-term adverse
health outcomes of some pathogens are increasingly recognized....
Association of Virulence Mechanisms with Specific Meningococcal Infections Specific disease manifestations of meningococcal infections have specific virulence and pathogenic mechanisms, as described below for fulminant meningococcemia and meningitis.
Purpura Fulminans Fulminant meningococcemia is perhaps the most rapidly lethal form of septic shock experienced by humans. It differs from most other forms of septic shock by the prominence of hemorrhagic skin lesions (petechiae, purpura; see Fig. 52-5) and the consistent development of DIC.
Harrison's Internal Medicine Chapter 136. Meningococcal Infections
Definition Neisseria meningitidis is the etiologic agent of two life-threatening diseases: meningococcal meningitis and fulminant meningococcemia. More rarely, meningococci cause pneumonia, septic arthritis, pericarditis, urethritis, and conjunctivitis. Most cases are potentially preventable by vaccination.
Etiologic Agent Meningococci are gram-negative aerobic diplococci. Unlike the other neisseriae, they have a polysaccharide capsule.
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: A CC and CXC chemokine levels in children with meningococcal sepsis accurately predict mortality and disease severity...
Invasive Meningococcal Disease results from bacterial infection with Neisseria meningitidis,
a gram-negative aerobic organism that is usually a commensal in humans; 5-25% of adults
are asymptomatic carriers.
Meningococci that cause invasive disease develop a capsule that
protects the organism from host defence mechanisms.
Neisseria meningitidis is the etiologic agent of two life-threatening diseases: meningococcal meningitis and fulminant meningococcemia. More rarely, meningococci cause pneumonia, septic arthritis, pericarditis, urethritis, and conjunctivitis. Most cases are potentially preventable by vaccination. Etiologic Agent Meningococci are gram-negative aerobic diplococci. Unlike the other neisseriae, they have a polysaccharide capsule. They are transmitted among humans—their only known habitat—via respiratory secretions.
Despite the success of the Men C programme the youngest members of society continue to
bear a disproportionate burden in terms of incidence of, and mortality from, IMD. The recorded
case fatality rate (CFR) for meningococcal disease varies between 2.6-10% each year (see table
accompanying Figure 1), similar to the 5.6% observed in England and Wales.
This guideline makes recommendations on best practice in the recognition and management
of meningococcal disease in children and young people up to 16 years of age. It addresses the
patient journey through pre-hospital care, referral, diagnostic testing, disease management,
follow-up care and rehabilitation and considers public health issues. The guideline will be of
interest to healthcare professionals, parents and carers who are involved in the diagnosis and
management of children and young people with suspected or confirmed meningococcal disease.
The right to health is NOT the same as the right to be
healthy. A common misconception is that the State has to
guarantee us good health. However, good health is influenced by
several factors that are outside the direct control of States, such as
an individual’s biological make-up and socio-economic conditions.
Rather, the right to health refers to the right to the enjoyment of a
variety of goods, facilities, services and conditions necessary for its