health talk:with Dr Johannes Marisa
When we were growing up, we used to hear stories of goblins striking people with resultant excruciating headaches that used to take life. We were made to believe that such headaches were from witches and wizards. A lot of people, therefore, shunned medical treatment and turned to all sorts of perceived treatments. Unfortunately, most of them died. Post-mortems done showed meningitis as the cause of death. The World Health Organisation in 2015 approximated that 8,7 million people got meningitis with about 379 000 deaths.
What is meningitis? Meningitis is inflammation of the membranes (meninges) that surround your brain and spinal cord. The swelling typically triggers symptoms such as headache, fever and stiff neck. Most cases of meningitis are caused by viral infections but bacterial and fungal infections are very common. Bacteria like Meningococcus, Streptococcus Pneumoniae and Mycobacteria Tuberculosis are common causes as well as fungi like Cryptococcus Neoformans. The mentioned bacteria and fungi are quite common in immunosuppression like HIV and Aids.
Signs and symptoms
Early meningitis symptoms may mimic flu. Symptoms may develop over several hours or over a few days. These include:
lSevere headache that seems different from normal.
lSudden high fever.
lConfusion or difficulty concentrating.
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lSeizures
lSensitivity to light
lHeadache with nausea or vomiting
lSkin rash (sometimes, such as in meningococcal meningitis).
It is imperative that we take a look at signs and symptoms in the new-borns and infants. These include:
lHigh fever
lExcessive sleepiness or irritability
lPoor feeding
lA bulge on fontanelle (Kufuta panhova)
lStiffness in the baby’s neck or body.
Infants with meningitis may be difficult to comfort and may even cry harder when held.
Causes
Viral infections are the most common cause of meningitis, followed by bacterial infections and lastly fungal infections. Bacterial meningitis
This can occur when bacteria enter the blood and travel to the brain and spinal cord. Bacterial can directly invade the meninges as in the case of ear infection, sinus infection, skull fracture and some surgeries. Several strains of bacteria can cause bacterial meningitis but common are:
lStreptococcus pneumonia
lNeisseria Meningitidis (meningococcus)
lHaemophilus influenza
lListeria monocytogenes
lMycobacterium Tuberculosis (usually chronic meningitis).
Fungal meningitis
Cryptococcal meningitis is a common fungal form of the disease that affects people with immune deficiencies such as Aids. It is life-threatening if not treated with an antifungal medication.
Risk factors
lCompromised immune system like in Aids, diabetes, cancer patients on Immunosuppressant drugs.
lThose who had spleen removal have higher risk so they should get vaccinated to minimise the risk.
lPregnancy increases the risk of listeriosis. Listeriosis increases the risk of miscarriage, stillbirth and premature delivery.
lMost cases of viral meningitis occur in children below five years. Bacterial meningitis is common in those under age 20.
lSkipping vaccinations: Vaccines for bacteria like Meningococcus are available so make sure your child is covered as well.
Prevention
Common bacteria and viruses that can cause meningitis can spread through coughing, sneezing, kissing or sharing utensils, toothbrush or a cigarette. The following steps can thus help prevent meningitis:
lWash your hands to avoid spread of gems.
lFor those who are HIV-positive, maintain your CD4 on the high side so that your body is in a position to fight. For those with low CD4, keep protected from fungal meningitis by taking Fluconazole tablets daily till your defence is high.
lAvoid pigeon droppings and gum trees for those with advanced HIV and Aids as they are big sources Cryptococcus Neoformans.
lSome forms of bacterial meningitis are preventable with the following vaccinations:
lHaemophilus influenza vaccine.
lPneumococcal conjugate vaccine.
lMeningococcal conjugate vaccine.
Diagnosis
lMeningitis can be diagnosed based on medical history, a physical examination and certain tests. Signs of infection around the head, ears, throat and skin along the spine.
lLumbar puncture should be done for definitive diagnosis. Fluid from the spine is collected (CSF). Sugar levels and protein levels should be examined. Further
CSF analysis may identify which bacterium caused the meningitis.
NB** Lumbar puncture is necessary upon suspicion of meningitis. I have heard false stories about lumbar puncture, some patients claiming that once it is done on anyone, then the patient will die instantly. That is a big false.
lComputed Tomography (CT Scan) or Magnetic Resonance Imaging of the head may show swelling or inflammation.
Treatment Treatment depends on the cause, but acute bacterial meningitis should be treated immediately with intravenous antibiotics and sometimes corticosteroids.
lIf Tuberculosis meningitis, use TB drugs
lIf fungal meningitis, make use of antifungals like Fluconazole, Amphotericin B
lDr Johannes is a private medical practitioner who can be accessed on [email protected].
