Ziad Elnasser, MD, Ph.D
Blood brain barrier.
CSF and its circulation.
Routes of infection
Occult or overt.
G –ve diplococci, size variations.
Growth conditions and media.
Significance of iron.
Quellung reaction, group A and C.
13 serotypes: A, B, C, D, X, Y, Z, E, W135,
H, I, K and L.
A, B, C, X, Y, Z, W135, and L has been
Group C divided into Neuraminidase R or S.
Serogrouping and antibiotics resistance?
Group B not immunogenic.
Noncapsular Cell wall Antigens
Like other G –ve bacteria.
Lipo-oligosaccharide (12 serotypes).
Similar to human Glycosphingolipid
Lipo-oligosaccharides as future vaccines.
Classification based on Serotyping, OMP
Phase and antigenic variation.
Attachment to nasopharyngeal cells.
Colonies of Piliated and nonpiliated are
the same not as that of Gonococci.
Ciliated or nonciliated.
Pili and attachment to MCPs (CD46).
Opa and Opc role.
Only non encapsulated strains invade?
Actin rearrangement and porin protein.
IgAase and Pil C role and BB barrier.
Group A antigen and Bacillus pumilis.
E. coli K1 antigen and Group B.
Neonatal tissue and group B.
Some times not protective.
IgAase only in pathogenic strains.
Presence of the meningococci in healthy
Carrier state and epidemic status, >20%.
Carrier to carrier via respiratory route.
Normal flora role.
Group B is the most common (9.6months).
Invasion and newly infected patients.
Upper respiratory tract infection and
5 – 19 years old during epidemic.
Fatality rate 2 – 10% and in septicemia
up to 70%.
Low socioeconomic status and poverty.
Serotypes and different epidemic
School children, military recruits and
Ranges from mild fever to septicemia
and fulminant death.
Bacteremia without sepsis, upper
respiratory tract infection.
Meningococcemia, leukocytosis, skin
rash, headache and hypotention.
Meningitis with or without septicemia.
Children vs adults.
CSF and Blood.
Synovial, pleural, petechial skin and
mucosal lesions and pericardial.
Chemical and cytological examination.
CIE, latex agglutination, coagglutination.
Lactate dehydrogenase and
PCR value if antibiotics were used.
Antibiotics reduced mortality and supportive
care improved prognosis.
First generation cephalosporins?.
Second and third generation cephalosporins.
Value of early treatment.
Treat complications caused by LPS.
TNF alpha and other cytokines as indicators
Steroids? Low dose.
Plasmin activator with fibrinolysis for DIC.
Sulfonamides reduced the carrier state.
Penicillin proved to be ineffective.
Rifampin and minocycline.
House hold contacts, medical personnel,
nursery schools, military barracks
Capsular polysaccharides A and C.
Erythema and irritability in some.
Not effective before 24 months of age.
Day care centers.
Now quadrivalent of A, C, Y and W135 is
Detoxified LOS and OMP, Capsule protein
conjugate, anti-idiotype antibodies.
Yeast , large capsue unique,
Bacterial like colonies.
Pigeon and birds droppings in soil.
No human to human transmission.
Inhalation of yeast or conidia.
Minimal signs and symptoms.
CNS is the primary target.
Common complication of AIDS.
Humoral and CMI role.
Meningitis, skin, pneumonia.
Slow insidious onset.
Headache, irritability, dizziness and
Seizures, cranial nerves, papillidema,
In AIDS 5 - 15% becomes infected.
CSF pleocytosis, lymphocytes
predominance, Sugar, protein.
Microscopy, negative staining.
Amphotericin B + Flucytosine.
Relapse is a problem, chronic.
Residual neurological damage.
Self limiting to severe.
Meningitis vs encephalitis and clinical
Viral infections in the immune suppressed.
Slow viral infections.
Acute Aseptic Meningitis Syndrome
Lymphocytic choriomeningitis virus.
Acute lymphocytic pleocytosis in the CSF.
No involvement of the brain paranchyma.
Normal sugar and slight protein increase.
Clinical course is usually mild.
Trimethoprim, Ibubrufin, Carbamazipine.
IV Immunoglobulin injection.
Treatment is supportive.
Like viral meningitis but more severe
symptoms, seizures to coma.
Togaviruses, mosquitoes, summer to fall.
St. Louis encephalitis.
Eastern Equine Encephalitis.
Western Equine Encephalitis.
HSV-2 some times HSV-1.
Acute widespread necrotizing infection of the
newborne. Cervical infection and the baby.
Very high mortality or sever retardation.
HSV-1 and cold sores, frontal and temporal.
Acyclovir is effective mortality drops from 70
Viral infections in the immune
PML and the JC virus.
Chronic demyelinating disease.
Hodgkin's, Lymphoma, Leukemia and HIV.
CSF studies are completely normal.
HIV and AIDS.
Slow Viral diseases
SSPE and mealses.
PRPE and Rubella.
Cretzfeldt-Jacob disease (prog. Dementia).
Familial Fatal Insomnia.
Bovine Spongiform encephalopathy.
Scrapie, Transmissible Mink encephalopathy,
chronic wasting disease.