Question: This 19-year old student was in his usual state of health until the ev

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Question:

            This 19-year old student was in his usual state of health until the evening prior to admission, when he went to bed with a headache. He told his mother that he felt feverish, and on the following morning his mother found him in bed, moaning and lethargic. He was brought to the emergency room, where he appeared toxic and drowsy but oriented. His temperature 40'C, his heart rate was 126/min, and his blood pressure was 100/60 mm Hg. His neck was supple. He had an impressive purpuric rash, not blanching, most prominent on the trunk, legs and wrists. His white blood cell count was 26,000/ul with 25% band forms. The platelet count was 80,000/ul.

         Blood cultures were obtained, a lumbar puncture was performed, and the patient was begun on intravenous ceftriaxone. Cerebrospinal fluid (CSF) glucose, protein, and white blood cell count were normal, and CSF bacterial culture was negative. Blood cultures grew a Gram Negative diplococci.

1. What is the organism causing his illness? Is the finding of a normal CSF profile without evidence of meningitis commonly observed in infection with this organism? Explain.

2. Is this organism ever part of the normal oropharyngeal microbiota? Explain.

3. How is this disease spread? How can infection be prevented?

4. What is a purpuric rash, and which virulence factor plays a central role responsible for its appearance?

Explanation / Answer

1.

The organism causing his illness is Neisseria meningitidis. It is a non-motile, gram-negative diplococci bacteria. It gets transferred from one host to the other via direct contact with body fluids. Finding a normal Cerebrospinal fluid (CSF) profile without evidence of meningitis is not an appropriate finding, as the bacteria attaches to the meninges in the brain.

2.

Yes, the organism Neisseria meningitidis is a normal oropharyngeal microbiota in about 40% of the adults. It is found in the oropharyngeal region, as it can be transferred by aerosol or by the exchange of saliva.

3.

The organism Neisseria meningitidis primarily attaches to the epithelial cells in the nasopharynx. It then invades the mucous membrane and enters the blood stream. Once entering the blood stream, it travels all through the body and finally attaches to the meninges in the brain.

This disease spreads from one person to the other via direct contact with body fluids. It can be prevented by maintaining a healthy lifestyle, getting plenty of rest, not coming into close contact with the persons who are sick, being hygenic and maintaining proper hygenic conditions, etc. Rifampin, Ceftriaxone or Ciprofloxacin are suggestable for treating the persons who come in close contact with sick individuals.

4.

Purpuric rash can be a manifestation of disseminated intravascular coagulation (DIC). Lipooligosaccharide (LOS), a component of the outer membrane of Neisseria meningitidis acts as an endotoxin and is responsible for septic shock and hemorrhage due to the destruction of red blood cells. Polysaccharide capsule is the other virulence factor that protect the organism from host phagocytosis.

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