Meningococcal Septicaemia/Meningitis

In document Blue Book (Page 135-141)

A case of meningococcal infection has occurred in a child at this school/creche/child minding centre/kinder-garten.

This disease generally spreads to close intimate and household contacts and can progress very quickly.

The indications of this illness to look for are fever, rash, intense headache, nausea and often vomiting. Serious signs include drowsiness, neck stiffness, delirium, coma and sudden collapse. Even the earliest sign (that is, fever), in such contacts warrants immediate medical attention from your local doctor or the nearest hospital.

Please take this letter with you.

The most important period in which to look for these signs is up to 10 days from the last date of contact with the patient.

If you need any further information, please telephone:

Public Health Nurse or Medical Officer, Infectious Disease Unit: (03) 9616 7777.

Meningoencephalitis (Primary Amoebic)

Victorian Statutory Re q u i re m e n t

Group A notification.

Infectious Agent

Naegleria fowleri, Acanthamoeba culbertsoni and other species of Acanthamoeba, Balamuthia mandrillaris.

Clinical Features

It is a serious disease of brain and meninges.

Naegleria spp enter the brain via the nasal mucosa and olfactory nerve and causes a syndrome of fulminating pyogenic meningoencephalitis with sore throat, severe headache, neck stiffness and death within 10 days, usually on the fifth or sixth day.

Acanthamoeba spp invade through skin lesions and spread to the brain and meninges causing insidious and prolonged disease. Balamuthia spp appears to behave similarly and prolonged skin lesions may be present.

Public Health Significance and Oc c u r re n c e

It is a rare disease with a high case fatality rate.

Infection with N. fowleri occurs mainly in young people as opposed to infection with Acanthamoeba spp that attacks the chronically ill or immunosuppressed.

Meningoencephalitis due to N. fowleri has been reported from the USA, Europe, Australia, New Zealand. PNG, Thailand, India, West Africa, Venezuela and Panama.

Cases caused by Acanthamoeba spp have been re-ported from Africa, India, Korea, Japan, Peru, Venezuela, Panama and the USA.

Two cases notified in Victoria in 1992 and one in 1996 were caused by a free-living amoeba hitherto regarded as an innocuous soil organism incapable of infecting mammals. This is the Balamuthia mandrillaris. It is a rare cause of meningoencephalitis.

Method of Diagnosis

It can be diagnosed by:

• Microscopic examination of fresh CSF.

• Culture on non-nutrient agar plates spread with bacte-ria (for example, E. coli).

• Culture on cell cultures of monkey kidney (Balamuthia spp).

Re s e r voi r

The amoebae are free-living in water, soil and vegetation.

Mode of Transmission

Naegleria fowleri: By diving, jumping into, or underwater swimming in warm, fresh water, stagnant ponds or lakes, or inadequately maintained public heated swimming pools, when water is forced into the nose.

Acanthamoeba culbertsoni: Haematogenous spread from the site of primary colonisation (for example, damaged skin mainly in chronically ill or

immunosuppressed patients) with unknown source of infection.

Incubation Period

Usually three to seven days for N. fowleri; longer for Acanthamoeba spp.

Period of Communicability

There is no person-to-person transmission.

Control of Case

No isolation, concurrent disinfection or quarantine is necessary.

Tre a t m e n t

Amphotericin B, miconazole and rifampicin. Recovery from infection is rare.

Control of Contacts

Investigation of contacts and source of infection should take place.

Preventive Measures

• Educate the public on the danger of swimming in lakes and ponds where the infection has been acquired.

• Maintain a residual chlorine of 1 to 2 ppm in swimming pools.

• Chlorinate public water supplies that are naturally warm.

Epidemic Measures

Any grouping of cases needs proper epidemiological investigation.

M u m p s

Method of Diagnosis

Mumps is usually diagnosed clinically.

Serologic tests (CF, HAI, EIA) are useful in confirming the diagnosis.

The virus can be isolated in duck embryo or cell cultures from saliva, blood, urine and CSF during the acute phase of the disease.

Re s e r voi r

Humans.

Mode of Transmission

It is transmitted by droplet spread and by direct contact with saliva of an infected person.

Incubation Period

Usually 12–25 days; commonly 18 days.

Period of Communicability

It is communicable from six days before to nine days after the onset of swelling of glands.

Maximum infectivity occurs 48 hours before onset of illness.

Inapparent infection can be communicable.

Susceptibility and Resistance

Immunity is lifelong and develops after inapparent and clinical infections.

Control of Case

Exclusion from school, child care or workplace until nine days after the onset of swelling.

No specific treatment.

Mumps is an acute viral disease characterised by fever, swelling and tenderness of one or more salivary glands, usually the parotid.

Orchitis occurs in 20–30 per cent of postpubertal males, and oophoritis in about 5 per cent of females. Involve-ment of the CNS results in meningitis, encephalitis or meningoencephalitis in up to 15 per cent of cases but permanent sequelae are rare.

Nerve deafness is one of the most serious of the rare complications (one in 500 hospitalised cases). Pancreati-tis, neuriPancreati-tis, arthriPancreati-tis, mastiPancreati-tis, nephriPancreati-tis, thyroiditis and pericarditis may also occur.

Public Health Significance and Oc c u r re n c e

Occurrence is worldwide. Serologic studies show 85 per cent or more people have had mumps infection by adult life.

Most infections in children less than two years of age are subclinical.

Due to effective immunisation, the greatest risk of infec-tion has shifted to older children, adolescents and young adults.

Control of Contacts

Isolation is unnecessary.

Susceptible contacts should be offered immunisation.

Preventive Measures

Live attenuated vaccine is available singly or combined with rubella and measles.

It is recommended for all children at any age after 12 months, unless specific contraindications to live vaccines exist.

Two doses of MMR vaccine are recommended: the first at 12 months and the second at 10–16 years (or Year 6 in Victoria).

Epidemic Measures

Susceptible persons should be immunised, especially those at risk of exposure.

Those who are not certain of their immunity can be vaccinated if no specific contraindications to live vaccines exist.

In document Blue Book (Page 135-141)

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