Without the White Coat
By Florentino P. Alerta II, M.D.

Meningo… better prepared than being scared

There is always that nightmare when not knowing what's gonna hit us as we walk down the street or suddenly we got hit by a swerving motor vehicle in the middle of nowhere. In that moment of our lives we never anticipated what really hit us for the simple reason we really don't know or we were never prepared. Accidents and calamities may come in the least expected moments, but what happens if we can prevent it from happening? One part of the battle against diseases is the knowledge of what causes it, the symptoms it brings, the complications that it will render, and lastly the medical treatment for it. Diseases has its own pathology and epidemiology, thus as physicians we can now expect how to cure it. It is like knowing the enemy before the battle starts or begins. Much more prepared for any preventive and curative measures thus preventing further complications and even death.

Meningococcal infection (cerebrospinal fever) in which meningococcemia (meningococcal meningitis) belongs, tends to be a big challenge to our public health officers especially that situation that affected Baguio City. I may have written in the past on articles on meningeal infection or meningococcemia scare in Baguio in which we already have forgotten how it presents in the early stage of the infection.

Meningococcal meningitis is not actually the plain “meningitis” that we see in the pediatric wards of our medical institutions. By dealing with problem straight from the face then we can be assured that only a few or none of the complications can thus be observed. Meningococcemia is an acute bacterial disease that is characterized by a sudden onset of fever , intense headache , nausea and often vomiting, a stiff neck accompanied in some times with a petechial rash with a pink macule , with a rare instant discovery of vesicles. Coma in some cases are expected and occasional fulminating cases that exhibit prostration, shock, ecchymoses then shock will ensue. Case fatality rates that exceeds 50%, and again with early diagnosis and early medical intervention and support the case-fatality rates are between 5 to 15%. Colonization of Neisseria meningitides in the nasopharynx region of the upper respiratory tract is found in 5 to 10% of the population in countries that are endemic in meningococcemia and are asymptomatic. A food for thought for some clinician a small minority of persons that acquire the infection will eventually progress into the invasive form of the disease, characterized by one or more clinical syndromes that includes bacteremia, sepsis, meningitis and pneumonia. In some cases of sepsis a petechial rash will develop, with some joint involvement. In some cases of meningococcemia it is not always true that it will involve the meninges or extensions to the cerebrospinal compartment, thus suspicion will arise in cases of unexplained acute febrile illness associated with petechial rash and leukocytosis. In the stage of fulminating meningococcemia the death rate becomes so high despite prompt medical intervention with antibacterials.

Diagnosis is confirmed in the recovery of meningococci from the cerebrospinal fluid or blood. Coagglutination techniques can be utilized and gram stain from the petechial rashes may reveal the microorganism.

Your friendly Family Physician recommends: the mode of transmission is thru direct contact from the respiratory system as droplets from the nose and the throat, incubation period varies from 2 days to 10 days with average of 3 to 4 days. Those that susceptible to the clinical disease is low and decreases with age, there is a high ratio of carriers that prevails. Those that are deficient in certain complement components are prone to recurrent of the disease. Patient that have undergone the removal of their spleen are prone to bacterial illness.

Preventive measures can further be undertaken like educating the public for the need to reduce direct contact and exposure to droplet infection. Avoid overcrowding in the workplace, schools, ships, and camps. Meningococcal vaccines are effective in adults.(quadrivalent vaccine—containing Groups A,C,Y and W-135 meningococcal polysaccharides.) There should be a control of patient contacts and the immediate environment, report to the local health unit any cases and start isolation (respiratory) for 24 hours after the start of therapeutic therapy. Disinfection of discharges from the nose and throat and protection of contacts thru close surveillance of households or intimate contacts should be assessed first for early signs of the illness, especially with regards to fever. Initiation of appropriate prophylactic therapy for those with close contacts with patient like sulfonamides, rifampicin, ceftriaxone, ciprofloxacin and suldadiazine should be started. There should be an investigation of contacts and the source of infection.

In cases that there will be an outbreak or epidemic of cases it is always stress that emphasis must always be placed on careful disease surveillance, early diagnosis, and the immediate medical treatment of suspected cases. Separate individuals and properly ventilate living quarters for those that are exposed. Rifampicin reduced the carrier rate and thus limit the spread of the disease, but not recommended for mass prophylaxis due to appearance of resistant strains. Meningococcal vaccines has shown to be very effective in stopping epidemics due to A and C serogroups.

If you have any question on Meningococcemia don't hesitate to drop us a line at The News Today.