Neurology · MU Sofia

43. Meningococcal meningitis, secondary purulent meningitis

Covers meningococcal meningitis caused by Neisseria meningitidis, moving through its pathogenesis, clinical picture with meningococcaemia and rash, CSF findings, complications, treatment and prevention. It then turns to secondary purulent meningitis arising from ENT, traumatic, surgical or haematogenous sources, with its common pathogens and CSF profile. A comparison table sets the two types side by side on onset, rash, source, shock and causative organism.

Inside: 1 section · 1 table · 16 flashcards · 2 min

Topic 43 of 88 in the MU Sofia syllabus for Neurology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 243 words (2 min of reading), with 16 flashcards.

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  1. Meningococcal menintis. Secondary purulent meningitis

Meningococcal menintis. Secondary purulent meningitis

1. Meningococcal Meningitis

Definition: Acute purulent meningitis caused by Neisseria meningitidis, often occurring in epidemics and affecting children, adolescents, and young adults.

Pathogenesis

  • Nasopharyngeal colonization → bloodstream invasion
  • Crossing blood-brain barrier → meningeal infection
  • Endotoxin release → severe systemic inflammatory response

Clinical Features

  • Onset: Acute, rapidly progressive (hours–days)
  • Meningeal Syndrome: Severe headache. High fever. Neck stiffness. Photophobia. Vomiting
  • Systemic Features : Toxic appearance. Hypotension, shock. DIC (disseminated intravascular coagulation)
  • Meningococcemia (key feature): Petechial or purpuric rash. Can progress to hemorrhagic lesions. Waterhouse-Friderichsen syndrome (adrenal failure)

CSF Findings: ↑ Opening pressure. Turbid/purulent CSF. ↑↑ Neutrophils. ↑ Protein. ↓ Glucose. Positive Gram-negative diplococci

Complications: Septic shock. DIC. Adrenal hemorrhage. Brain edema. Death (rapid course if untreated)

Treatment

  • Emergency antibiotics (e.g., ceftriaxone/cefotaxime)
  • Supportive ICU care
  • Corticosteroids (in selected cases)
  • Chemoprophylaxis for contacts (rifampicin/ciprofloxacin)

Prevention: Meningococcal vaccination. Isolation of patient during acute phase

2. Secondary Purulent (Bacterial) Meningitis

Definition: Meningitis that develops secondary to another infectious focus in the body.

Causes (Sources of Infection):

  • ENT sources: Otitis media. Mastoiditis. Sinusitis
  • Trauma / Surgery: Skull fractures. Post-neurosurgical infections
  • Hematogenous spread: Pneumonia. Endocarditis
  • Common Pathogens: Streptococcus pneumoniae (most common in adults). Neisseria meningitidis. Staphylococcus aureus (post-trauma/surgery). Gram-negative bacilli (hospital-acquired)

Clinical Features: Acute onset fever. Severe headache. Neck stiffness. Vomiting. Altered consciousness (in severe cases)

CSF Findings: Turbid CSF. ↑↑ Neutrophils (dominant feature). ↑ Protein. ↓ Glucose. Increased opening pressure

Key Differences: Meningococcal vs Secondary Purulent Meningitis

Complications (both types): Brain edema. Hydrocephalus. Cranial nerve palsies. Sepsis. Death if untreated.

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