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Eighty four cases of meningococcal infections are reviewed. Fifty seven cases presented themselfs as meningococcal meningitis, twelve cases as sepsis with moderate hypotension and 15 cases were sepsis with septic shock. A brief course of the disease, shock, echymosis, absence of meningeal signs, leucopenia and intravascular coagulation were findings more frequent in the group of patients with hiperacute sepsis, whereas other signs as fever, headaches, vomiting and petechiae were present with equal frequency in the three groups. N. meningitis was isolated in 73% of the cases. Shock (18.85%) and intravascular coagulation (12%) were the complications more frequently found, followed by convulsions (4.81%), arthritis (4.81%), skin necrosis (4.81%), subdural efusion (3.57%), cerebral palsy (3.40%), thrombophlebitis (1.20%), recurrence (1.20%), inapropiate antidiuretic hormone secretion (1.20%) and subaracnoideal hemorrage (1.20%). The overall mortality was 10.70% and 60% of the patients which initially presented with shock and intravascular coagulation died. Autopsy findings included wide spred hemorragic lesions and intravascular thrombi in skin, mucous membranes and viscera. Adrenal hemorrhage was present in five of the six cases studied.
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PMID:[Incidence, clinical, forms and complications of meningococcal infections (author's transl)]. 41 52

The clinical and laboratory findings, and the results of treatment of 16 Meningococcal meningitis cases, who were hospitalized, are investigated, and discussed with the literature. On application all of the patients had headache, meningeal irritation findings, and fever (% 75), nausea and vomiting (% 62.5), rash (% 56.25), unconsciousness (% 50), coma state (% 31.25), Herpes labialis (% 31.25), affecting of cranial nerves (% 12.5), arthritis (% 12.5), and carditis (% 6.25). At the peripheric blood examinations, all had leucocytosis, and neutrophilia. In the direct examination of the cerebrospinal-fluid, in 15 patients gram negative diplococci were seen, and in 11 patients the microorganisms grew on culture. The patients were given Crystalized-Penicillin in doses of 20-30 million IU/day. In the two cases some complications, resistance, and allergy developed, so the treatment changed. Only a patient died, and in the other cases no relapse and sequel were seen.
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PMID:[Meningococcal meningitis in adults]. 208 30

In order to stop an outbreak of group A meningococcal meningitis, 130,000 Auckland children were immunised. During the month following vaccination there were 546 reports of unusual clinical events reported by parents and practitioners, together with 40 specialist paediatric assessments of children presenting with neurological symptoms. In 25 of these latter there was complete agreement between the history as presented by parents in the initial telephone report and the paediatrician's subsequent summarised history. Of the 546 reports, 217 either had too little detail for an assessment or the symptoms were clearly attributable to other causes. Of the remaining reports, there were 152 cases of fever with or without other symptoms; 85 were of rash and local reactions within 24h of vaccination; 63 reports were of headache, stiff neck and myalgia within 48h of vaccination. There were 92 reports of apparent peripheral nerve involvement, including 80 reports of unexplained weakness and 57 reports of paraesthesia or dysaesthesia. Both motor and sensory symptoms occurred in some children; none were permanent. The effects of adverse publicity during the campaign on the genesis of some symptoms is acknowledged, but the possibility that short term neurological symptoms occur after vaccination seems likely and has not been previously reported.
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PMID:Meningococcal vaccine--do some children experience side effects? 291 16

A 44-year-old man with a history of presumed meningococcal meningitis 32 years before, presented with a three-month illness, characterized by fever, 13.5-kg (30-lb) weight loss, occipital headache, shoulder pain, and muscle weakness, which had been diagnosed as "polymyositis" and treated accordingly. Evaluation revealed meningococcal meningitis due to serogroup W135 and a C5 deficiency. Evidence for the occurrence of chronic meningococcal meningitis is described.
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PMID:Chronic meningococcal meningitis. An association with C5 deficiency. 313 25

One hundred twenty four cases of meningococcal meningitis were seen at the Ethio-Swedish Children's Hospital (ESCH) during the epidemic period December 1, 1987 to January 31, 1989. Data on demographic and clinical profile of patients were collected and analyzed. Two thirds of patients were above 5 years of age. Fifty percent of the patients came from the "mercato area" of the city of Addis Abeba, Higher 3, 4, 5 & 6. Thirteen cases were from outside Addis Abeba. The main clinical presentations were fever and vomiting in all age groups and headache in those above 5 years of age. The classical meningeal signs were rare in those below 5 years of age. The most common neurological deficit was loss of hearing. Mortality was very low (only 3 deaths). Continuous surveillance of demographic and clinical indicators is recommended as they could be useful early warning signs of an epidemic.
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PMID:Epidemic meningococcal meningitis in children. A retrospective analysis of cases admitted to ESCH (1988). 843 1

Meningococcal meningitis has been occurring worldwide in both endemic and epidemic forms. Serogroup A accounts for majority of cases of epidemic as well as endemic Meningococcal meningitis in developing nations, whereas group C and group B causes epidemic and endemic meningococcal meningitis in developed countries. Person to person spread of N. meningitides generally occurs through inhalation of droplets of infected nasopharyngeal secretions by direct or indirect oral contact. Incubation period varies from 2 to 10 days. N. meningitides typically causes acute infective illness characterized by sequential development of upper respiratory tract infection, meningococcemia, meningitis and focal neurological deficit. Over 90 per cent cases of adult meningococcal infections have cerebrospinal meningitis, whereas in children prevalence of meningitis is much lower (50 per cent). Acute meningitis manifests with fever, severe headache, vomiting and neck stiffness. Presentations may be non-specific in infants, elderly and in patients with fulminant meningococcemia. Diagnosis is confirmed with cerebrospinal fluid analysis. Overall mortality due to meningitis is usually around 10 per cent. In meningococcal septicemia, the case fatality rate may exceed 50 per cent. Preventive strategies include vaccination, chemoprophylaxis and early detection and treatment. Mass vaccination campaign, if appropriately carried out, has been documented to halt an epidemic of meningococcal disease due to serogroup A or C. In the present review we have discussed the available evidence with regards to prevention at primary, secondary and tertiary level. Public health approach to an outbreak of meningococcal meningitis in a community or an organization is also outlined.
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PMID:Meningococcal meningitis outbreak control strategies. 1166 37

The emergence of meningococcal strains with reduced susceptibility to penicillin has been reported in several countries during the past two decades, but not in Taiwan. We report a case of meningococcal meningitis with intermediate resistance to penicillin. A 20-year-old male soldier complained of chills, fever, and headache for 2 days, followed by drowsiness. Physical examination revealed erythema of the pharynx, stiff neck, erythematous maculopapules, and petechiae over the trunk and four limbs including palms and soles. Analysis of the cerebrospinal fluid (CSF) showed a white blood cell count of 9.06 x 10(6)/L, a glucose concentration of 0.165 mmol/L, and a protein concentration of 7.85 g/L. CSF culture yielded Neisseria meningitidis, serogroup B. The minimum inhibitory concentration of penicillin was determined using an E-test (0.125 microgram/mL); there was no beta-lactamase production. He recovered after high-dose penicillin G treatment with six doses of 24 million units per day for 11 days. The emergence of penicillin resistance in N. meningitidis in Taiwan requires surveillance. High-dose penicillin may be successful in treating penicillin-insensitive meningococcal meningitis. Alternative treatment with third-generation cephalosporins should be considered if poor response to penicillin is encountered.
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PMID:Meningitis due to penicillin-resistant Neisseria meningitidis in a 20-year-old man. 1176 Mar 76

Spinal cord dysfunction is a rare complication of Neisseria meningitidis (meningococcal) meningitis. We report a 17-year-old patient who had a 3-day history of fever, headache and vomiting, agitation, and unresponsiveness. Cerebrospinal fluid showed a marked polymorphonuclear pleocytosis. Latex particle agglutination was positive for meningococci. The patient was given intravenous antibiotics and intravenous dexamethasone. Over the next 4 days, he developed weakness of the lower extremities, with areflexia and extensor plantar responses. MRI revealed contiguous hyperintensities on T2-weighted images involving the thoracic spinal cord from T4 to T9 and 4 brain abscesses. Five months later, he recovered brain function, but the paraparesis remained. This case illustrates that myelopathy may complicate acute meningococcal meningitis, possibly due to a vasculitis, stroke, autoimmune myelopathy, or direct infection of the spinal cord. Patients with myelopathy associated with acute meningitis should receive spinal MRI. In addition, meningitis should be considered in patients presenting with acute myelopathy.
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PMID:Thoracic myelopathy complicating acute meningococcal meningitis: MRI findings. 1201 69

Meningococcal septicaemia has high mortality, especially when the diagnosis is delayed or missed. Early recognition is not always straightforward, as classic clinical features may be absent or overlooked at initial presentation. Septicaemia without focal infection accounts for 15%-20% of cases of meningococcal disease and is the most worrisome manifestation in terms of diagnosis and outcome; in contrast, meningococcal meningitis is usually straightforward to diagnose, with a relatively good prognosis. Useful early clinical clues to meningococcaemia include: - a haemorrhagic (petechial or purpuric) rash; - blanching macular or maculopapular rash that appears in first 24 hours of illness; - true rigors; - severe pain in extremities, neck or back; vomiting, especially in association with headache or abdominal pain; rapid evolution of the illness; - concern of parents, relatives or friends; - patient age (highest incidence at age 3-12 months, followed by 1-4 and then 15-19 years); and - contact with a patient with meningococcal disease. In addition to specific clues, clinicians should look at the whole pattern of the illness. Timely clinical review is essential if there is doubt about the diagnosis. In any acutely febrile patient, it is prudent to ask "Why is this patient seeking help now?", then "Could this patient have meningococcaemia?".
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PMID:Early clinical clues to meningococcaemia. 1255 87

This study had three objectives: firstly, it aimed to examine an appropriate model for preventing and controlling the risk of meningococcal disease as a result of an epidemic carrying by returning pilgrims at Hat Yai International Airport; secondly, it aimed to establish the number of meningococcal carriers among pilgrims returning from Saudi Arabia; thirdly, it considered the health problems that arose during the Hajj pilgrimage. A structured questionnaire was used to collect data from 374 pilgrims at the Hat Yai airport checkpoint between March 15th and April 2nd, 2001. Each subject provided a naso-pharyngeal swab and reported on their health status by postcard once they had reached their homes 7-10 days later. It was found that most of the pilgrims were from Satun Province (23%). The average age was 50.5 years (range 20 to 86; SD 12.8). More than half of the pilgrims had some knowledge of meningococcal meningitis. Most, about 80.7%, knew that vaccination against meningococcal infection is required before traveling to Saudi Arabia. About 77.8% were vaccinated at the Provincial Health Office (PHO) in their hometown. Nearly 19% had underlying diseases such as chronic cough, asthma, diabetes, hypertension, headache and rheumatism. During their pilgrimage some were troubled by symptoms of respiratory tract disease, fever and headache. All had negative laboratory results. Only 16.6% returned postcards describing their self-assessed health status. About 30.6% described themselves as healthy. Among those who reported sick, coughs, sore throats and stomach aches were prevalent. Health education and public information about vaccine need to be strengthened. The best place to get the vaccination is their hometown PHO. Trained health personnel, instead of tour leaders or guides, should pay attention to the health of the pilgrims. The tour leaders are an important target group for improved health knowledge because most pilgrims will trust and follow them. Even though there were negative laboratory results, it is worth having a good surveillance system for meningococcal meningitis in order to prevent epidemics and reduce mortality among returning pilgrims.
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PMID:Surveillance for meningococcal carriage by Muslims returning from the Hajj to Hat Yai Airport, Thailand. 1297 92


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