Title: Neisseria meningitides
题目：脑膜炎奈瑟氏菌（流行性脑脊髓膜炎）
Author 作者: Lauren Rice

This winter season has brought a rise in influenza and RSV activity in Maryland and in many parts of the country. It is also important to remember other potentially lethal infections that are prevalent in the winter and early spring months, such as Neisseria meningitidis. In fact, a recent study2 showed a potential increase in meningococcal disease when influenza and RSV activity is high. 


这个冬季给马里兰和美国的许多地区带来了增高的流感和呼吸道合胞病毒的感染。同时我们也要记住其它在冬天和早春流行的潜在的致命感染，如脑膜炎奈瑟氏菌。
What: 
Encapsulated, gram-negative diplococcus

是什么：具有夹膜的革兰氏阴性双球菌。
Where: 
Found in nasopharyngeal secretions, carrier rates 2-30% in normal populations

在哪里：存在于鼻咽分泌物中，在正常人群中的携带率位2－30％。
Who: 
Age of incidence has 2 peaks: children < 2 years old, teens 15-19 years old
Young adults who live in shared housing, such as college dorms and military recruits


易感人群：感染年龄有两个高峰期：两岁以内的儿童，15－19岁住在集体宿舍（大学宿舍或募兵军营）的青少年。
Clinical Presentation:
Early non-specific symptoms of URI, fever, malaise, myalgias
Meningitis: non-specific prodrome + headache, stiff neck (not found in younger children who often present atypically with irritability and/or vomiting)
Meningococcemia: above symptoms + hypotension + petechial rash (>60% of patients)


临床表现：早期非特异的上呼吸道症状，如发烧，乏力，肌肉酸痛。脑膜炎：不特异的前期表现＋头痛，颈强（在小儿中不常见，他们多表现为不特异的易怒和／或呕吐）。脑膜炎球菌血症：上述症状＋低血压＋出血性皮疹（60％以上的病人）。
Treatment:
Early (!) antibiotics: 3rd generation cephalosporins (<3mo: cefotaxime; older infants, children, and teens: ceftriaxone); PCN G is antibiotic of choice for susceptible isolates
Early and aggressive management of shock


治疗：早期（！）抗菌素：第三代先锋（小于3个月：头孢噻肟；大一点的婴儿，儿童和青少年：头孢曲松）；青霉素G对敏感的菌群是早期和抢救休克时的首选的抗菌素。
Prevention:
Tetravalent vaccine, MCV4 (Menactra, Menveo), available for serogroups A, C, Y and W-135 is given routinely at age 11-12 years old with an additional booster at 16-17 years old. MCV4 does not protect against serogroup B which accounts for 30% of infections.
预防：四价流行性脑脊髓膜炎疫苗（血清A，C，Y和W－135型）－MCV4常规在11－12岁时接种，并在16－17岁时增强。MCV4对占30％感染的B型无效。

References 参考文献
1. Cross JT, Hannaman RA. Infectious Disease. MedStudy Pediatrics Board Review Core Curriculum: 5th edition. 2012; 5-11.

2. Jansen AG, Sanders EA, VAN DER Ende A, VAN Loon AM, Hoes AW, Hak E. Invasive pneumococcal and meningococcal disease: association with influenza virus and respiratory syncytial virus activity?. Epidemiol Infect. Nov 2008;136(11):1448-54.

3. Javid MH. Meningococcemia. Available at http://emedicine.medscape.com/article/221473. Medscape Reference. Last updated Aug. 2. 2012.