Monday May 26 2014

That flu could be meningitis


By Agatha Ayebazibwe

Meningitis is caused by bacteria and viruses that often live in human bodies, according to the Center for Diseases Control (CDC).
Normally, the germs stay in the intestines or in the nose and throat, where they may or may not cause sickness.

Dr Anthony Mbonye, the Commissioner for Community Health in the Ministry of Health says that if meningitis germs spread to the meninges – the tissues that surround the brain and spinal cord, they cause inflammation and that inflammation is Meningitis.
The germs that cause meningitis are contagious and can be passed from one person to another.

Different types of Meningitis
Meningococcal disease
According to Dr Henry Nabeta, a researcher at Infectious Disease Institute, Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the meninges that affects the brain membrane.
Dr Nabeta says that it can cause severe brain damage and that 50 per cent of those who get it die if untreated early.

“When the bacteria affect the meninges–brain coverings, there develops a lot of fluid and pus. That fluid squeezes the brain and as a result, signs and symptoms such as a stiff neck, convulsions, fever and cough begin to show,” explains Dr Nabeta.

In Uganda, it is the most common form of meningitis partly because the country is situated in the sub-Saharan meningitis belt.
The disease, according to Dr Mbonye, affects mostly districts in the northern part of the country which are situated in the meningitis belt like Arua, Adjumani, Koboko and Maracha and Kitgum among others.

Viral meningitis
Viral meningitis on the other hand, is caused by a virus that leads to inflammation of the soft tissue membranes, which cover the brain and spinal cord underneath the skull and spinal column.

“Most cases of viral meningitis are usually mild and most people recover faster than those with bacterial meningitis. However, some cases of viral meningitis can be life threatening or cause lasting after effects, particularly if people have problems with their immune system,” Nabeta further explains.

This type however, is also common in children although it can occur in any age group but mostly people with low immunity.
“Most of the patients we see at Mulago with viral meningitis are HIV positive and with low CD4 count,” Nabeta says, adding that this particular group is vulnerable to infections due to suppressed immunity.

Unlike the meningococcal meningitis, which is more common during dry season where droplets from one person to another are transferred through dust, viral meningitis is spread through direct contact from person to person by respiratory secretions or faecal matter.

How the bacteria spread
“The bacteria are transmitted from person-to-person through droplets of respiratory or throat secretions from carriers,” says Mbonye.
Usually, close and prolonged contact–such as kissing, sneezing or coughing on someone, or living in close quarters such as a dormitory, sharing eating or drinking utensils with an infected person–facilitates the spread of the disease, according to the World Health Organisation.

Because the presentation of the disease is usually the same for all meningitis, experts say it is very important to establish the particular type before treatment can be given.

This, according to Nabeta is due to the fact that bacterial meningitis is treated using different drugs from the ones that treat the fungal or viral meningitis.

“Bacterial is treated using bacteria, fungal is treated using fungi while viral meningitis presently has no cure although doctors treat the symptoms among the HIV positive people.”

Among those who survive, as many as 20 per cent live with permanent disabilities, such as brain damage, hearing loss, loss of kidney function or limb amputations as well as speech difficulties.

While prevention of meningitis is critical because it can be mistaken for flu or other viral infections, leading to rapid death or disability, in Uganda, little has been done to avail vaccines for the vulnerable groups especially those living in the meningococcal meningitis belt.
Health officials recommend routine vaccination for children at 11 to 12 years old with a booster dose at age 16 to help protect them from meningococcal disease.

Also, transmission of viral and bacterial meningitis can be prevented by raising the level of hygiene among persons at risk of infection as well as those who might be spreading the disease.

Who is at risk?
Experts say anyone can get meningitis, although some people have a higher risk for the disease. These include; adolescents and young adults, infants less than one year old, people living in crowded settings like college dorms or military barracks, people living in the meningitis belt in of Africa, and laboratory personnel who are routinely exposed to meningococcal bacteria among others.

The symptoms
Meningitis disease is often misdiagnosed because early symptoms can be similar to the flu or other viral infections.
The symptoms of viral meningitis tend to be the same as bacterial meningitis, with the latter potentially able to cause death within hours.
They include a headache, nausea or vomiting, fever, general malaise, neck stiffness, an aversion to bright lights, joint aches and pains, muscle aches, drowsiness or confusion, and also may include a rash, sore throat, stomach pains and diarrhoea.

Prevalence in Uganda
The total number of new cases reported weekly has remained stable ranging between 14 and 19 cases per week.
However, the number of cases reported increased to 29 in West Nile, of which 19 were from Adjumani District. Majority of cases (69 per cent) in Adjumani and Arua districts are children below 15 years.

These statistics notwithstanding, the World Health Organisation does not recommend that any travel or trade restrictions be applied to the Uganda with respect to this event.