MENINGITIS.

Doc, please tell us something about meningitis, and why does it occur during dry-season?
I was to discuss “marijuana”, this week, based on interactions with my young patients, but when two people from the Northern part of the country, who had no contact with each other, variously requested that I discuss meningitis, I acquiesced.
What actually is meningitis?
Meningitis is defined as an inflammation of the meninges, which surround the brain and spinal-cord. It is common in Northern Savannah of Africa, which includes Northern Nigeria, but can occur anywhere in Nigeria. The disease is known as “sankara”, by the Hausas, which means “stiff-neck”, according to Prof Perry, it is greatly feared in the North, and it is thought to be caused by evil spirits.
With advent of modern medicine, and the discovery of pencillin therapy, the disease is now easily treated.
Epidiomology of meningitis.
♥ Close contact of people promotes transmission of meningitis.
♥ Infected individuals usually carry the organism in the nose and throat for sometime, varying from 2 weeks to 10 months. This local infection immunizes the host from meningitis infection, but can still transmit it to whoever he comes in contact with.
♥ In a few people, who have no antibody to the invading strain, the organism enters the blood. Here it multiplies and causes septicaemia. In about 1 in 1000 people it lodges in the meninges to multiply further and cause meningitis.
♥ Epidemics of meningitis occur in a great belt of Northern Savannah, which stretches from old Sudan, and the north of Uganda across Chad, the North of Nigeria, southern Niger, into Ivory Coast and Mali.
♥ The number of cases of meningitis starts to increase as the temperature and humidity rise and reaches a peak in March and April when it is very hot, and humid, according to Prof E H Parry. The incidence drops sharply when the rains begin. The explanation, derived from studies conducted in Jos University Teaching Hospital (JUTH), is that during the cold dry season, people crowd together in the small huts for shelter. Transmission is high and the number of carriers increases greatly.
♥ The incidence of meningitis is highest in the 5 – 15 years of age, and more frequent in males. It is uncommon in the very young, and rare in the old, probably because they have frequently been exposed to meningococcus and are immune.
What are the clinical symptoms of meningitis?
■ Disease starts with fever.
■ Increasingly severe bursting headache, which may radiate down the neck.
■ Neck and back become stiff. Photophobia, patient lies curled up -meningism.
■ Young children may convulse.
■ 10% of patients complain of muscle and joint pains, plus abdominal pain with diarrhoea.
■ A few patients become blind or deaf, but this is not noticed in their confusion.
■ Conjunctivitis, sore throats and red spots on the body due to septicaemia.
■ Signs of heart failure may be present or develop, due to overload with intravenous fluid.
■ An occasional patient bleeds from the nose, with redness of the skin, and inflammation of the sclera.
■ There may be allergic complications, due to drug reaction.
How is meningitis treated? This is three pronged;
1) Ameliorate signs and symptoms – doctors and nurses will take charge.
2) Eradication of infections through intravenous drugs like benzy-penicillin and chloramphenicol.
3) Prevention of neurological sequelae.
★ Therapy is directed in the use of anti-microbial drugs based on spinal-fluid culture & sensitivity results.
★ Close family contacts should be given prophylaxis, to prevent secondary infection.
Are there vaccinations for meningitis?
a) Three vaccines target the three-types of bacteria that cause meningitis, available in all health centres in Nigeria
What is our take this week?
1) Now that dry season is approaching in Nigeria. We should avoid overcrowding and maintain adequate ventilation in our sleeping places.
2) Any child with fever, who shows signs of neck stiffness should be rushed to the nearest hospital immediately, and if meningitis is confirmed, all those who had come in contact with him should be given prophylaxis. Please be properly guided.
Dr Ojum Ekeoma Ogwo.