Without the Whitecoat
Meningococcemia, why the scare?
Due to unconfirmed report that a patient died of meningococcemia in one of the medical institutions in the city recently some folks have become so apprehensive and jittery. (The regional office of DOH never send out an advisory of an impending epidemic of meningococcemia or the case was either confirmed by hospital authorities, then why the scare?) Last year's situation in Baguio City was not even confirmed as an epidemic for meningococcemia by our health authorities, but all the drugstores had ran out of stocks of Ciprofloxacin. People tend to panic due to fatalities from some disease entity... from SARS, to the Avian Flu and now meningococcemia which are all transmitted through respiratory droplets or via air-borne transmission. As a medical practitioner I have already took care of cases of meningococcemia, so why the scare among our community. Apparently, the little knowledge or information that we have about meningococcemia causes the scare or a "little panic". Again the best way to deal with diseases or any type of illness is to know what it is, what causes it, how to deal with it, its effects on the community and how to treat and manage it medically. If said questions are addressed then more than half of the problem is already been taken care of.
Meningococcemia, is an acute bacterial infection caused by Neisseria Meningitidis (a normal inhabitant of the nasopharynx, epidemics are caused by the group A meningococcus) it is characterized by sudden onset of fever, intense headache, nausea, and often vomiting, stiff neck and some frequent appearance of petechial rash with pink macules with some appearance of vesicles (rare). In the fulminating stage, delirium and coma can be seen accompanied by ecchymoses, and sudden shock. (Fatalities will exceed 50%) With early diagnosis, modern therapy and supportive measures the case-fatality rate is between 5% and 15%.Remember that a small minority of persons who acquire the infection will progress to an invasive disease that will include bacteremia, sepsis, meningitis or pneumonia. In areas endemic of the infection 5 to 10 percent of the population will be asymptomatic carriers with the nasopharynx colonized with Neisseria Meningitidis. Many patients with sepsis will develop petechial rashes with some joint involvement. In some cases that there will be no involvement or extension to the meninges for cases of unexplained febrile condition associated with petechial rashes and leukocytosis (increase white blood cells) then we can suspect a case of meningococcemia. Diagnosis is done by the recovery of the meningococci from the cerebrospinal fluid or blood. Coagulation techniques like LA and CIE can also be utilized. Under microscopic examination the gram stained smears of petechial rashes may reveal the microorganism.
Educating the public is one way to prevent the spread of the disease and at the same time address the panic in the community. The need to reduce contact and exposure to droplet infection should be stressed out, reduce overcrowding in living quarters and workplaces such as camps, schools, ships and military barracks. Close surveillance of household and other intimate contacts for early signs of illness, especially fever to initiate therapy without delay and prophylaxis administration.
When an outbreak occurs, major emphasis must be placed on careful surveillance, early diagnosis and immediate treatment of suspected cases. A high index of suspicion is very valuable.
Before spreading rumors to start a meningococcemia scare, confirmed first any information with the proper medical authorities and medical specialists. A better and well informed community is much more prepared to handle any calamities or epidemics that will come its way.