Epidemic Cerebrospinal Meningitis

Epidemic cerebrospinal meningitis is purulent meningitis caused by N. meningitidis. The pathogen enters via the nasopharynx, causes septicemia, then localizes to the meninges. Features are high fever, headache, nausea/vomiting, petechiae, and nuchal rigidity with purulent CSF; peak in winter/spring. Treated with penicillin/ceftriaxone, bed rest, ventilation, coma care, anticonvulsants.

Common Symptoms

Sore throat; pallor; meningeal signs; severe headache; anorexia; impaired consciousness; septicemia; acute facies; labial herpes

Causes and Pathogenesis

The pathogen enters via the nasopharynx with cold-like symptoms (sore throat, rhinorrhea, nasal obstruction). Strong immunity clears it or causes carriage; lack of specific bactericidal antibody or high virulence leads to bacteremia and meningitis. Infantile cases are often atypical and misdiagnosed as colds. Bacteria invade dermal endothelium causing emboli, necrosis, hemorrhage, and petechiae; visceral hemorrhage follows thrombosis/thrombocytopenia/endotoxin. Fulminant septicemia (formerly Waterhouse-Friderichsen syndrome) is due to LPS-induced microcirculatory failure and DIC, not adrenal failure. Fulminant meningoencephalitis and Type III hypersensitivity also play roles. Stages may stop spontaneously. Onset is abrupt; most patients are <15 years, especially infants <1 year (smaller = more severe). Year-round sporadic, rising from February, peaking in March-April (~80% of annual cases in spring). Delayed treatment causes intellectual disability. Nm is a Gram-negative diplococcus, human-only, cold/dry/disinfectant sensitive, autolyzes easily—specimens must be cultured immediately.

Treatment

Drug therapy, supportive therapy

Preventive Measures

1. Early diagnosis/report/isolation. 2. Personal/environmental hygiene; sun bedding; ventilation. 3. Avoid crowds during epidemics; wear masks. 4. Seek care promptly for fever/sore throat/headache/vomiting/lethargy/petechiae. 5. Keep warm, prevent colds; dry sweat after exertion. 6. Eat raw garlic with meals; gargle with salt water. 7. Vaccinate children <5 in late autumn with meningococcal vaccine (~80-90% protection, ~1 year), annual booster. 8. Chemoprophylaxis: sulfadiazine 2 g/day (adults) in 2 divided doses with equal sodium bicarbonate ×3 days; children 100 mg/kg/day. Rifampicin 600 mg/day ×5 days (10 mg/kg for ages 1-12) abroad. 9. Vaccines: A/C capsular polysaccharide vaccines (94.9% protection, 14.1× antibody rise); emergency vaccination if incidence >10/100,000 in Jan-Feb or exceeds prior year.

Department to Visit

It is recommended to visit the Infectious Diseases department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.