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Meningococcal Meningitis

Overview

Meningitis is an infection of the meninges, the thin lining that surrounds the brain and the spinal cord. Several different bacteria can cause meningitis and Neisseria meningitidis is one of the most important because of its potential to cause epidemics. Meningococcal disease was first described in 1805 when an outbreak swept through Geneva, Switzerland. The causative agent, Neisseria meningitidis (the meningococcus), was identified in 1887.

Twelve subtypes or serogroups of N. meningitidis have been identified and four (N. meningitidis. A, B, C and W135) are recognized to cause epidemics. The pathogenicity, immunogenicity, and epidemic capabilities differ according to the serogroup. Thus the identification of the serogroup responsible of a sporadic case is crucial for epidemic containment. In the US the vaccines currently available cover A,C,W135 and Y. Cand B being the most common and B strinking infants and toddlers most. There is NO VACCINE FOR Group B.

How is the disease transmitted

The bacteria are transmitted from person to person through droplets of respiratory or throat secretions. Close and prolonged contact (e.g. kissing, sneezing and coughing on someone, living in close quarters or dormitories (military recruits, students), sharing eating or drinking utensils, etc.) facilitate the spread of the disease. The average incubation period is 4 days, ranging between 2 and 10 days.

N. meningitidis only infects humans; there is no animal reservoir. The bacteria can be carried in the pharynx and sometimes, for reasons not fully known, overwhelm the body’s defences allowing infection to spread through the bloodstream and to the brain. It is estimated that between 10 to 25% of the population carry N.meningitidis at any given time, but of course the carriage rate may be much higher in epidemic situations. Some experts believe that smokers carry the bacteria at a higher rate.

Features of the disease

The most common symptoms are stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. Even when the disease is diagnosed early and adequate therapy instituted, 5% to 10% of patients die, typically within 24-48 hours of onset of symptoms. However

Do you know the early signs of meningitis and blood poisoning which could improve detection of the disease and save lives?
Unrelenting fever, leg pain, cold hands and feet and abnormal skin color can develop within (12 hours) after infection long before the more classic signs of the illness such as a rash, headache, stiff neck, sensitivity to light and impaired consciousness, debilitation or death.

Anyone can get meningitis especially infants, children and teens.
 Bacterial meningitis may result in brain damage, hearing loss, or learning disability in 10 to 20% of survivors. A less common but more severe (often fatal) form of meningococcal disease is meningococcal septicaemia which is characterized by a haemorrhagic rash and rapid circulatory collapse.

Diagnosis

The diagnosis of meningococcal meningitis is suspected by the clinical presentation and a lumbar puncture showing a purulent spinal fluid; sometimes the bacteria can be seen in microscopic examinations of the spinal fluid. The diagnosis is confirmed by growing the bacteria from specimens of spinal fluid or blood. More specialised laboratory tests are needed for the identification of the serogroups as well as for testing susceptibility to antibiotics.

Treatment

Meningococcal disease is potentially fatal and should always be viewed as a medical emergency. Admission to a hospital or health centre is necessary. Isolation of the patient is not necessary. Antimicrobial therapy must be commenced as soon as possible after the lumbar puncture has been carried out (if started before, it may be difficult to grow the bacteria from the spinal fluid and thus confirm the diagnosis).

A range of antibiotics may be used for treatment including penicillin, ampicillin, chloramphenicol, and ceftriaxone. Under epidemic conditions in Africa, oily chloramphenicol is the drug of choice in areas with limited health facilities because a single dose of this long-acting formulation has been shown to be effective.

Epidemiology of meningococcal meningitis: who is affected and where

Meningococcal meningitis occurs sporadically in small clusters throughout the world with seasonal variations and accounts for a variable proportion of endemic bacterial meningitis. In temperate regions the number of cases increases in winter and spring. Serogroups B and C together account for a large majority of cases in Europe and the Americas. Several local outbreaks due to N. meningitidis serogroup C have been reported in Canada and USA (1992-93) and in Spain (1995-97). For 10 years, the meningococcal meningitis activity has particularly increased in New Zealand where an average of 500 cases occurs every year. Most of these cases are now due to serogroup B.

Major African epidemics are associated with N. meningitidis serogroups A and C and serogroup A is usually the cause of meningococcal disease in Asia. Outside Africa, only Mongolia reported a large epidemic in the recent years (1994-95).

There is increasing evidence of serogroup W135 being associated with outbreaks of considerable size. In 2000 and 2001 several hundred pilgrims attending the Hajj in Saudia Arabia were infected with N. meningitidis W135. Then in 2002, W135 emerged in Burkina Faso, striking 13,000 people and killing 1,500.

  US ACIP Recommendations

 

Children age 11-18 and College freshman, especially those who live in dormitories are at higher risk for meningococcal disease and should be educated in their high school senior year . A new recommendation from CDC is to vaccinate 11 and 12 year olds  - 24 year olds.

  Pneumococcal Meningitis: Pneumococcal disease are infections caused by the bacteria Streptococcus pneumoniae, also known as pneumococcus. The most common types of infections caused by this bacteria include middle ear infections, pneumonia, blood stream infections (bacteremia), sinus infections, and meningitis.

Young children are much more likely than older children and adults to get pneumococcal disease. Children under 2, children in group child care, and children who have certain illnesses (for example sickle cell disease, HIV infection, chronic heart or lung conditions) are at higher risk than other children to get pneumococcal disease. In addition, pneumococcal disease is more common among children of certain racial or ethnic groups, such as Alaska Natives, Native Americans, and African-Americans, than among other groups.

Each year in the US Streptococcus pneumoniae causes approximately 280 cases of meningitis, 4,600 cases of bacteremia or other invasive disease in children under the age of 5. Children under 2 average more than 1 middle ear infection each year, many of which are caused by pneumococcal infections. Streptococcus pneumoniae is the most common cause of bacteremia, pneumonia, meningitis and otitis media in young children.

Children at increased risk of pneumococcal infections include those with anatomic or functional asplenia ( including sickle cell disease), patients taking immunosuppressive chemotherapy, those with congenital and acquired immune deficiency (including HIV infections), those with chronic renal disease and healthy Native American, Alaskan Native, and African American children.

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Bacterial meningitis can cause sepsis.

These photos may not be copied or reproduced.© Meningitis Angels

This is what ultimately took the hearing, part of a leg, fingers from this little one's left hand, and still causing complications with the kidney and other extremities even 4 years later.

 

NOTE !!

 

Overseas travelers should check to see if meningococcal vaccine is recommended for their destination.  Information on areas for which meningococcal vaccine is recommended can be obtained by calling the

Centers for Disease Control and Prevention at

(404)-332-4565.

 

Fungal Meningitis

Some fungi can occasionally cause meningitis, but the disease is rare and usually occurs only in patients whose immune system has been severely depressed by disease, (eg. AIDS or leukaemia, or by drug therapy). Fungal meningitis may be slow and difficult to diagnose and treat.

The symptoms of all these forms of meningitis are similar. Hospital tests may be needed to tell the difference. If in doubt seek medical advice quickly.

 

 

Amoebic Meningitis

Amoebic meningitis is well known in hotter states of Australia. Despite its notoriety, amoebic meningitis is a very rare infection. It is caught from stagnant water in waterholes and in poorly chlorinated swimming pools, especially when the water temperature rises above 30C. Children can become infected when contaminated water is forced up the nose. The organism then reaches the base of the brain directly.

In Australia’s hotter regions children should not be allowed to swim in poorly chlorinated swimming pools or stagnant waterholes, particularly on very hot days. Young children should be discouraged from playing with hoses that may force water up their noses.

 

 

WARNING BACTERIAL MENINGITIS IS A LIFE & DEATH EMERGENCY 

If  you think you or someone you know has it,  CALL 911.