BACTERIA MENINGITIS

What is Meningococcal Disease?
Meningococcal disease is caused by the bacterium, Neisseria meningitidis. The severity of the disease can range from asymtomatic carrier state to an acute illness, either meningitis (infection of the brain covering), pneumonia (infection of the lungs), to meningococcemia (disseminated meningococcal infection), which can be mild or serious. It is quite common for patients to develop a mild upper respiratory infection before proceeding to an acute neisseria infection (acute meningtis). Spread is by cough droplets or close contacts. Symptoms include fever, chills, malaise, body aches, arthralgia, joint effusion, headache and petechial rash. In the most severe form of infection patient can develop low blood pressure and shock, resulting in death.

What is meningitis?
Bacteria meningitis can be quite severe and may result in brain damage, hearing loss, or learning disability. For bacterial meningitis, it is important to know which type of bacteria is causing the meningitis because antibiotics can prevent some types from spreading and infecting other people as well as treating the disease.

What are the signs and symptoms of meningitis?
High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. These symptoms can develop over several hours, or they may ake 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness. In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect, and the infant may only appear slow or inactive, or be irritable, have vomiting, or be feeding poorly. As the disease progresses, patients of any age may have seizures.

How is the meningitis diagnosed?
The diagnosis is usually made by blood and spinal fluid testing. Early diagnosis and treatment are very important. If symptoms occur, the patient should see a doctor immediately.

How can meningitis be treated?
Bacteria meningitis can be treated with a number of effective antobiotic. It is important, however, that treatment be started early in the course of the disease. Appropriate antibiotic treatment should reduce the risk of dying from meningitis, although the risk is higher among the elderly.

Is meningitis contagious?
Yes, some forms of bacterial meningitis are contagious. The bacteria are spread through the exchange of respiratory and throat secretions (i.e., coughing, kissing). Fortunately, none of the bacteria that cause meningitis are as contagious as things like the common cold or the flu, and they are not spread by casual contact or by simply breathing the air where a person with meningitis has been.

However, sometimes the bacteria that cause meningitis have spread to other people who have had close or prolonged contact with a patient with meningitis caused by Neisseria meningitidis (also called meningococcal meningitis) or Hib. People in the same household or day-care center, or anyone with direct contact with a patient's oral secretions would be considered at increased risk of acquiring the infection. People who qualify as close contacts of a person with meningitis caused by N. meningitidis should receive antibiotics to prevent them from getting the disease.

Are there vaccines against meningococcal meningitis?
Yes, there are vaccines available for protection of the public in the event of an outbreak and there are various antibiotics that are used for close contacts of patients proven to have meningococcal infections.

The quadrivalent A, C, Y and W-135 vaccine is the most commonly used.

Dosage is a single dose of 0.5ml given under the skin. Vaccination is effective in up to 85 - 95% of older children (4 - 5 years of age) and adults. In those less than 4 years of age, vaccination may elicit protection but the protective antibodies is less and last for much shorter period of time.

Protective antibody may be achieved within 7 - 10 days. Levels of antibodies against serogroup A & C decrease markedly during the first three years. Common adverse reactions post vaccination are pain, redness at injection site for 1 - 2 days, transient fever, headache, malaise and chills.

Chemoprophylaxis antibiotic coverage for close contacts:
Adults: Rifampicin* 600mg 12 hourly x 2 days
or Ciprofloxacin 500mg stat
or Ofloxacin 400mg stat

Children:
> 1 year: Rifampicin 10mg/kg 12 hourly x 2 days
< 1 year: Rifampicin 5mg/kg 12 hourly x 2 days

Pregnant women: IM Ceftriaxone 250mg stat

*Rifampicin may cause red urine.