Without immediate treatment, meningitis is fatal 

Allen Kalule lost her son to meningitis. The 13-year-old had experienced about 10 days of confusion followed by fevers, chills, and vomiting. When he was taken to Mulago National Referral Hospital in Kampala, upon examination, the doctors realised he had an infection in his right ear canal. The bone behind the ear was also tender.

From the symptoms, Kalule was told that her son was suffering from meningitis and he needed immediate treatment. He was admitted and given intravenous ceftriaxone, an antibiotic recommended as the primary drug in the treatment of meningitis.

However, by the fourth day, there was no improvement. The boy still had a fever and he was weak. The doctors suggested adding metronidazole to his treatment but the following day, he developed a headache, became irritable and agitated. 

“Antibiotic treatment was continued but he had seizures on the sixth day of treatment and was taken into the intensive care unit. He was also put on stronger antibiotics but he failed to respond to the treatment. The doctors said he had started experiencing acute respiratory failure and on the tenth day, he died,” Kalule says.

What is meningitis?
Meningitis is an infection that causes inflammation of the fluid and membranes (meninges) surrounding the brain and spinal cord. If not treated, meningitis may result in death, brain injury, epilepsy, paralysis, blindness and hearing loss.

Causes 
According to Dr Richard Idro, a paediatric neurologist at Mulago National Referral Hospital, of the commonest causes of the inflammation is a virus that may enter the body through the nose as well as those that may enter the body through what we eat and then move to the small intestine and the blood. Viral infections such as mumps, measles, herpes viruses, influenza and the West Nile viruses can also cause meningitis. 

“The most severe meningitis is caused by bacteria and must be treated as a medical emergency since it is fatal. Bacteria that enter the bloodstream and travel to the brain and spinal cord cause bacterial meningitis. Bacterial meningitis can also occur when bacteria directly invades the meninges. This may be caused by an ear or sinus infection, a skull fracture and, although rarely, some surgeries,” he says.

Haemophilus influenzae type b (Hib) bacterium was the leading cause of bacterial meningitis in children in Uganda before the introduction of the vaccine in June 2002 according to Dr Idro, claiming about 50 percent of all the cases. With the introduction of the new Hib vaccines, the number of cases reduced greatly. 
Streptococcus pneumonia is a common bacterium that causes pneumonia, ear or sinus infections. This bacterium is the most common cause of bacterial meningitis in infants, young children and adults and a vaccine can help prevent this infection.

“The Neisseria meningitides is a bacterium that causes bacterial meningitis called meningococcal meningitis. These bacteria commonly cause an upper tract respiratory infection but can cause meningococcal meningitis when they enter the bloodstream. This is a highly contagious infection that affects mainly teenagers and young adults. However, a vaccine can help prevent infection,” says Dr Idro. 

Source
According to Dr Sabrina Kitaka, a paediatrician and infectious disease specialist at Mulago National Referral Hospital, the Listeria monocytogenes bacteria are commonly found in unpasteurised cheese, hot dogs and lunch meats. 

“Pregnant women, newborns, the elderly and those with weakened immune systems are most susceptible to this type of bacterial infection. During pregnancy, it can cross the placenta and if a mother catches it late in pregnancy, it may cause a miscarriage or stillbirth,” she says.

Besides the acute cases, meningitis can be caused by slow-growing organisms such as fungi (candida and Mycobacterium tuberculosis), which affects the lungs. They invade the membranes and fluid surrounding the brain and develop over a period of two weeks or more. 

Fungal meningitis is often contracted by breathing in fungal spores that may be found in soil, decaying wood and bird droppings. It is not contagious but commonly affects people with weakened immune systems, such as those who have Aids. It can cause death if not treated.

Parasitic meningitis can be caused by a tapeworm infection in the brain or cerebral malaria. Amoebic meningitis is a rare type but is sometimes contracted through swimming in fresh water and can quickly become life-threatening.

Who is at risk?
All children are at risk of catching meningitis, especially that caused by pneumococcus and haemophilus influenzae type B. However, those below the age of five are more at risk. The elderly, children and teenagers who skip vaccination and those whose immune system is compromised and suppressed such as those living with HIV, tuberclosis, and cancer bear a high risk of meningitis. 

Signs and symptoms
If one has meningitis, they may have symptoms such as headache, nausea, sudden high fever, drowsiness, vomiting, joint pain, stiff neck and a bulging fontanel. Other symptoms include irritability, general body weakness, confusion and inability to concentrate, seizures, sensitivity to light, poor appetite and constant crying in infants

Early treatment of bacterial meningitis can prevent serious complications. Therefore, Dr Kitaka recommends immediate medical care if you suspect that you or someone in your family has meningitis. Bacterial meningitis is serious and can cause death within days without prompt antibiotic treatment. Delayed treatment also increases the risk of permanent brain damage.

Meningitis can be diagnosed by taking medical history, physical examination and certain tests. The commonest tests include a blood culture where a blood sample is grown in the laboratory to see what microorganisms grow. A computed tomography (CT) or  magnetic resonance imaging (MRI) scan of the head can show swelling or inflammation of the membranes. 

The most important test according to Dr Idro is the definitive spinal tap, which requires the neurosurgeon to collect cerebrospinal fluid for examination. 
“This is an important test because it helps the doctor to know the type of germ causing the meningitis and the type of medication required to treat it,” he says.

Treatment
Treatment for meningitis depends on the type. Acute bacterial meningitis must be treated as soon as possible with intravenous antibiotics and corticosteroids to ensure recovery and reduce the risk of complications such as convulsions and brain swelling. 
Cases of viral meningitis are usually mild and can improve with bed rest, plenty of fluids and pain relievers. There are antiviral medicines for viral meningitis in case of a herpes virus.

Hospital stay-time of treatment for a patient with meningitis according to Prof Idro can be between 10 to 21 days or more, depending on how the patient responds to medication.

Complications
According to Dr Idro, the longer you or your child has the disease without treatment, the greater the risk of seizures and permanent neurological damage, including hearing  and sight loss, memory problems, learning disabilities, brain damage, trouble walking, epilepsy, kidney failure, shock, hydrocephalus (the buildup of fluid in the cavities (ventricles) deep within the brain) and death, among others.

Prevention
Common bacteria or viruses that can cause meningitis can spread through coughing, sneezing, kissing, or sharing eating utensils, a toothbrush or a cigarette. Dr Kitaka, therefore, warns people to be mindful.

“Practice good hygiene such as careful hand washing with soap to prevent the spread of germs. Children should be taught to wash their hands before eating and after using the toilet,” she warns. 

Whenever possible, avoid crowded places; wear a face mask to protect yourself from inhaling germs. When you need to cough or sneeze, cover your mouth and nose. Even as members of the same family, you should avoid sharing drinks, food, straws, eating utensils, lip balms or toothbrushes within the family or with anyone else. 

Get enough rest, exercise regularly, and eat a healthy diet with plenty of fresh fruits, vegetables and whole grains.
Avoid cheese made from unpasteurised milk.

Vaccination 
Some forms of bacterial meningitis are preventable with vaccinations such as Haemophilus influenzae type b vaccine (Hib). WHO and the Centres for Disease Control and Prevention (CDC) recommend this vaccine for children and it is estimated to prevent almost 30,000 cases of severe Hib disease and 5,000 deaths of those under five years annually. The vaccine is also recommended for some adults living with sickle cell disease and HIV/Aids. 

The pneumococcal conjugate vaccine (PCV) was made available in Uganda in January 2014 and it is part of the routine vaccination for children. It is administered at six, 10 and 14 weeks. 

These vaccines are also part of the CDC recommended routine vaccination schedule for children younger than twoyears. Additional doses are recommended for children between the ages of two and five who are at high risk of pneumococcal disease, including children who have chronic heart or lung disease or cancer.

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