Telephonefaxe-mail moc. All rights reserved Abstract A case of group A streptococcal meningitis is reported in a year-old girl with a history of recurrent otitis media. She presented to the emergency room with an altered level of consciousness; the organism was isolated from her spinal fluid and blood.
Meningococci are classified into serogroups on the basis of the composition of the capsular polysaccharide. Meningococcal disease is hyperendemic in this region, and periodic epidemics during the dry season December— June reach up to 1, cases perpopulation.
Although meningococcal outbreaks can occur anywhere in the world, they are most common in the African meningitis belt, and large-scale epidemics occur every 5—12 years. Historically, outbreaks in the meningitis belt were primarily due to serogroup A.
However, with the introduction of a monovalent serogroup A meningococcal conjugate vaccine [MenAfriVac] in the region starting inrecent meningococcal outbreaks have primarily been due to serogroups C Case pre meningitis W, although serogroup X outbreaks are also reported. Outside the meningitis belt, infants and adolescents have the highest rates of disease.
In meningitis belt countries, high rates of disease are seen in people up to age 30 years but are highest in children and adolescents aged 5—14 years. Risk for travelers is highest in people visiting meningitis belt countries who have prolonged contact with local populations during an epidemic.
The Hajj pilgrimage to Saudi Arabia has also been associated with outbreaks of meningococcal disease in returning pilgrims and their contacts. Areas with frequent epidemics of meningococcal meningitis1 1 Disease data source: International Travel and Health.
Meningococcal meningitis is characterized by sudden onset of headache, fever, and stiffness of the neck, sometimes accompanied by nausea, vomiting, photophobia, or altered mental status.
Meningococcemia is characterized by an abrupt onset of fever and a petechial or purpuric rash. The rash may progress to purpura fulminans. Meningococcemia often involves hypotension, acute adrenal hemorrhage, and multiorgan failure.
Neck stiffness, usually seen in people with meningitis, may be absent in this age group. A lumbar puncture should be done to examine the cerebrospinal fluid CSF and perform a Gram stain.
If possible, the lumbar puncture should be done before starting antibiotic therapy to ensure that bacteria, if present, can be cultured from CSF. Diagnosis is generally made by isolating N. The signs and symptoms of meningococcal meningitis are similar to those of other causes of bacterial meningitis, such as Haemophilus influenzae and Streptococcus pneumoniae.
The causative organism should be identified so that the correct antibiotics can be used for treatment and prophylaxis. Meningococcal disease is nationally notifiable.
Antibiotic treatment must be started early in the course of the disease, and empirically prior to the diagnostic test results. Several antibiotic choices are available, including third-generation cephalosporins. Refer to Table for more information about available meningococcal vaccines. Approximately 7—10 days are required after vaccination for the development of protective antibody levels.
A single dose of vaccine should be administered at age 11 or 12 years, and a booster dose should be administered at age 16 years. Routine immunization with MenACWY is not recommended for other age groups in the United States, with the exception of people at increased risk for meningococcal disease.
Those at increased risk for meningococcal disease include people who have a persistent complement component deficiency C3, C, properdin, factor D, or factor H or people who are taking eculizumab [Soliris]people who have functional or anatomic asplenia, or people with HIV.
Vaccine, product, number of doses, and booster dose recommendations are based on age and risk factor and are described in detail for each risk group in the ACIP Meningococcal Disease Recommendations www. Adolescents and young adults aged 16—23 years may also be vaccinated with a serogroup B meningococcal MenB vaccine to provide short-term protection against most strains of serogroup B meningococcal disease.
The preferred age for MenB vaccination is 16 through 18 years. Travelers to the Kingdom of Saudi Arabia KSA for Umrah or Hajj are required to provide documentation of quadrivalent vaccine at least 10 days and no more than 3 years before arrival for polysaccharide vaccine and no more than 8 years before arrival for conjugate vaccine see www.
Current visa requirements should be confirmed with the KSA embassy. Although the KSA Ministry of Health currently advises against travel to Hajj for pregnant women or children, these groups should receive meningococcal vaccination according to licensed indications for their age if they travel.Case Pre -Meningitis Meningitis is inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges.
The inflammation may be caused by infection with viruses, bacteria, or other microorganisms, and . Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges.
The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. Young children often exhibit only nonspecific symptoms, such as.
Cases of bacterial meningitis which have not been pre-treated with antibiotics almost always have more than 90% segs. The gram stain does not show any organisms which makes bacterial meningitis less likely.
This will probably turn out to be a case of viral meningitis despite the high percentage of neutrophils, since an early viral. In , Koplik reported the first case of neonatal meningo-coccal meningitis (NMM) in a 3-day-old infant born after a pro-longed labor.
The baby survived, but later developed hydrocepha - ity rate reported in patients under 2 years of age.3 In the pre-antibiotic era, there were 11 cases of meningitis reported, with.
Meningitis is an inflammation (swelling) of the protective membranes covering the brain and spinal cord. A bacterial or viral infection of the fluid surrounding the brain and spinal cord usually causes the swelling.
Histopathology of bacterial meningitis: autopsy case of a person with pneumococcal meningitis showing inflammatory infiltrates of the pia mater consisting of neutrophil granulocytes and it seems that meningism was known to pre-Renaissance physicians such as Avicenna.