Most of us have probably heard the news recently about cases of meningitis, a very serious affliction that has killed a number of people in America. This deadly disease can occur in people of all age groups, but very young individuals (infants and young children) and the elderly are more susceptible or even predisposed to the infection. Having said this, many patients do recover completely and survive following effective treatment, but such also depend on the type of the disease a person contracted.
Understanding First is Key
The brain and the spinal cord are surrounded by “cerebro-spinal fluid,” which acts as a cushion and protection for the central nervous system. Even greater protection is provided by the “meninges,” which are the membranes that cover the brain and spinal cord.
“Meningitis” is a disease involving inflammation and/or irritation of the meninges. This disease can have lasting effects on a person’s ability to think and learn, can cause hearing loss, and can even be fatal. Infection of the meninges can be caused by direct infection from another part of the body. The infection can be rooted or start in the skin, respiratory tract, the nose, throat or even the intestinal or genitourinary tracts. The most common source, however, is the respiratory tract.
The effective agents reach the meninges through the bloodstream or directly via a nearby infection such as in an ear, the nose or throat. Once the infective agents enter the nervous system, they survive hardly because of the lact of immune response in the system.
Generally, the body has natural defenses against infection even if someone is exposed to a virus or bacteria that can cause meningitis. If a person is infected, the body’s immune system will go to work to fight it. However, there are certain infections that can “outsmart” the immune system and weaken it. Some can even invade the central nervous system, and one of them is meningitis.
The different forms of this disease are classified according to the infective agent that caused it, namely bacteria, viral or fungal meningitis. Viral meningitis, the most common but less serious form of meningitis, is caused by ubiquitous viruses such as polioviruses. These types of viruses affect the digestive tracts from fecal contamination and a large number of what are referred to as non-polio enteroviruses (such as those of the common cold), which affect the nasal passages. Like most viruses, the route of transmission is through saliva, feces and nasal discharge. The risk of contact is very low and doesn’t normally require public health measures to be taken because, while the virus may be passed on by carrier-person, it very rarely causes another person to become infected.
Bacterial meningitis, on the other hand, is by far the most dangerous and sometimes fatal. It can be passed on by the transfer of bodily fluids from close contact with an infected person. In the Philippines, bacterial meningitis is one of the top causes of death among children less than four years old. This can be attributed to unsanitary living conditions. While bacterial meningitis is endemic in the country, active cases are relatively few.
Rare but Deadly
The rarest but also most deadly type is fungal meningitis. Usually the result of inhaling emanations from soil contaminated with bird and bat droppings, as well as other decaying organic matter, people with weak immune systems, especially those with AIDS or cancer, are at the highest risk.
Fungal meningitis is not highly contagious, meaning it is not easily transmitted from person to person. It may develop from prolonged use of medications that can suppress the immune system such as steroids, medications for post-organ transplant, treatment for rheumatoid arthritis and other autoimmune conditions.
According to experts at the American Centers for Disease Control and Prevention, the people who recently died of fungal meningitis in the US had received injections from three tainted lots of “methylprednisolone acetate,” a steroid used in six pain clinics. It is highly unlikely Filipinos will get fungal meningitis unless they live in environments where the fungal spores grow.
Although the signs and symptoms of meningitis are dependent on its type and the age of the patient, most cases are manifested by a severe headache that won’t go away, high fever and a stiff neck. These primary symptoms can be accompanied by nausea, vomiting, photophobia, confusion and irritability. Some of these signs and symptoms cannot be detected in an infant so lethargy and irritability are important signs. Upon contracting the disease, symptoms can appear very quickly or take a couple of days to do so, but anyone who experiences them needs to seek medical care immediately.
What Doctors Do
When someone has symptoms of meningitis, a doctor will first ask many questions to ascertain the possibility of affliction. The next step in diagnosing is by culture and analysis of the cerebro-spinal fluid extracted from the meninges. This fluid will be analyzed to determine if the causative organism is a bacterial, viral or fungal type.
A person with the very serious bacterial meningitis will need to be hospitalized for treatment. Strong antibiotic medicine will be given through an IV (“Intravenus,” a thin tube that funnels the antibiotic into a vein) to help destroy the infection. Fluids containing glucose and minerals may also be given through the IV to help a person recover.
Viral meningitis can be serious but is usually not as serious as bacterial meningitis. A patient with viral meningitis also needs hospital confinement for a few days and it may take weeks before he or she feels better or fully recovers. Antibiotics do not work against viruses so a person with viral meningitis will need to boost his or her immune system with ample rest and proper nutrition to subdue the virus.
To diagnose fungal meningitis, computerized scans such as CT or CAT or MRI with powerful magnets are utilized. Sometimes, a lumbar or lower-spine puncture is done to extract spinal fluid, which is then tested. These tests check for infection, bleeding around the brain and spinal cord or other irregularities.
The treatment depends on the causative organism. When meningitis is first suspected, a broad-spectrum antibiotic is readily administered to treat probable bacterial infection because early treatment in such cases is vital. After the organism has been isolated from the cerebro-spinal fluid, appropriate organism specifies treatment may then be instituted.
Can Meningitis Be Prevented?
Meningitis typically results from contagious infections. A person is also at increased risk if he or she lives or works with someone who has the disease.
The following steps can help prevent meningitis:
1) Thorough washing of hands is important to avoid exposure to infectious agents. The right way is to scrub hands vigorously, covering both the front and back of each hand with soap and rinsing thoroughly under running water. It is advisable to teach children to wash their hands often, especially before they eat and after using the toilet, spending time in a crowded public place or petting animals.
2) It is wise to cover mouth and nose when coughing or sneezing, or when around people who do.
3) A strong immune system can be maintained by getting enough rest, exercising regularly and eating a healthy diet with plenty of fresh fruits, vegetables and whole grains.
4) The significance of immunization as a matter more of prevention than of cure should not be undermined and, in fact, should never be understated. Some forms of bacterial meningitis are preventable with vaccinations. A regular immunization schedule for children younger than two years is recommended because they will be at higher risk when they reach the age range of 2-5.
5) Lastly, if someone gets bacterial meningitis in the neighborhood or school, doctors warn against close contact with that person. Close contact means living with or spending a lot of time or sharing food and fluids with the person. People who have been in close contact with the sick should consult a doctor just in case they were infected by the bacteria.
Awareness and Education is Key
Perhaps ‘worry’ is not the word, but ‘vigilance’ against meningitis is definitely sound practice. Individuals, families and communities should learn the telltale signs of the disease and recognize the importance of immediate and urgent treatment. Prevention is realistic against many causes and forms of meningitis, and can be successfully accomplished by educating ourselves about the disease.
Although the signs and symptoms of meningitis are dependent on its type and the age of the patient, most cases are manifested by a severe headache that won’t go away, high fever and a stiff neck.