Meningitis: Another Killer On The Loose

As in the case of previous epidemics that swept through populations, consuming lives and thereby landing a high fatality rate on these populations. Several diseases arrive in a twinkle of the eye and as they are met with suddenness, little or nothing is done to combat them promptly. Most times, the authorities are not equipped with the necessary tools. Early suspicion and signs would have helped and they would have been tackled and many lives would have been saved. There is strong note in seeking expert advice in the context of complications and important warning signs. A rapid spread of bacteria and viruses is not concurrent with the multiplication of deaths.

Causation and origin

Meningitis is a condition characterized by fever, neck stiffness, sensitivity to light, cold, vomiting and muscular pain or tenderness, headache, and meningismus with inflammation in the subarachnoid space as evidenced by CSF pleocytosis.

The brain and spinal cord are surrounded by a lining called the meninges. Infection or inflammation of the meninges is called meningitis. There is normally a fluid between the meninges and the brain or spinal cord called cerebrospinal fluid (CSF); in meningitis, the CSF becomes infected.

The time to presentation (acute, sub acute, or chronic) and timing of the illness disagree based on the etiology and guide appropriate initial management and treatment. Acute infection usually presents within hours to days, whereas chronic meningitis is usually longer than 4 weeks in duration. Acute meningitis is infectious with a bacterial or viral origin, with noninfectious etiologies in the differential diagnosis. Acute bacterial meningitis affects all ages and was mostly a pediatric disease until the beginning of the Haemophilus influenzae type b vaccine (HIB).

Presently, most cases occur in young and older adults. The most common organisms from the order are Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, group B streptococci, and H. influenzae, while the predisposing and associated conditions predict the etiologic agent and choice for appropriate initial treatment. Initially, the treatment is broad, with the goal of determining the causative organism for a particular therapy. Viral meningitis outnumbers meningitis and vice versa depending on the race and region.  In general, meningitis due to bacteria (bacterial meningitis) is more severe than meningitis caused by viruses (viral meningitis). Most children with viral meningitis recover completely. Some children with meningitis may have long-term problems, but this depends on the cause of the infection and the age of the child. Viral meningitis is caused by predominantly a few viral groups with neurotropism; often enteroviruses, herpes viruses, arboviruses, or HIV; and rarely mumps. Typically, a CSF pleocytosis with a lymphocytic predominance is present, and bacterial cultures are negative.

People at risk

Anyone is at risk of contacting meningococcal disease. Some people are placed at higher risk than others. This disease occurs more often in people who are:

  • Teenagers or young adults
  • Infants younger than one year of age
  • Living in crowded settings, such as university or school dormitories or military barracks or camps
  • Travelling to areas that are infected with meningitis such as the “meningitis belt” of Africa
  • Living with a distorted spleen or no spleen
  • Being treated with a vaccine that is not compatible with the body or who have complement component deficiency (an inherited immune disorder)
  • Exposed during an outbreak
  • Working with meningococcal bacteria in a laboratory

Spread

Even with the widespread availability of effective and reliable therapy, the morbidity and mortality of bacterial meningitis remain substantial, which stresses the prompt recognition and management of potential cases. Acute meningitis is infectious in most cases and caused by a potentially vast range of bacterial and viral pathogens. Changes in the epidemiology of bacterial pathogens have been induced by changes in vaccines and their implementation. Seasonal and environmental changes influence the likely viral and rickettsial pathogens. The organized method to the patient with suspected meningitis enables the prompt administration of antibiotics and diagnostic testing with neuroimaging and spinal fluid analysis. Relevant testing and treatment can vary with the clinical presentation, season, and possible exposures. Touching or contact of infected individuals is a way of spreading. Contact includes kissing, sharing drinks, or living together. Up to one in 10 people carry meningococcal bacteria in their nose or throat without getting sick

Treatment

It is imminent to always take the child for immunization. This is the first step to avoiding infection and it is helpful in the long run throughout the child’s growth.

Bacterial meningitis can be treated with antibiotics while viral meningitis may require very little treatment. The way a child is affected by the illness is different for each child.

The fluid surrounding the spinal cord, known as CSF can be sampled to see if it is infected by using a needle which is put into the back. This is called a lumbar puncture. The needle is inserted between two bones in the spine (the vertebrae) and into the CSF. The needle does not go into the spinal cord. The CSF from the back is just like the CSF around the brain and therefore gives the same information when tested.

 

This article was written by Alex Ndace. He tweets via: @AlexNdace; culled from Issue 16

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