14 March 2009
What is meningitis?
Meningitis is an inflammation of the tissues covering the brain, called
meninges. The brain and spinal cord are wrapped around by the meninges, with
fluid, the cerebro-spinal fluid, in between. The surrounding meninges and the
cerebro-spinal fluid provide protection for the brain and the spinal cord.
There are many types of meningitis. These are:
* Bacterial meningitis: This is caused by infections of the meninges with
bacteria, of which there are many types. For example Meningococci, Haemophilus
Influenzae and Streptococcus Pneumoneae (or Pneumococci).
Infections with Meningococcus (the most dangerous of the bacterial
infections) occur throughout the year, with peaks in the incidence starting in
May through to August and September.
Bacterial meningitis can be fatal if not diagnosed and treated. Meningitis
caused by Meningococci can be spread from person to person in situations such
as close contacts in a home or between babies in the same room within a
nursery.
All bacterial meningitis is treatable with antibiotics. Where Meningococcal
meningitis is confirmed or suspected, chemo-prophylaxis with oral antibiotics
is administered to all close contacts.
* Viral meningitis: This is due to infection caused by viruses like HIV,
mumps, herpes and chicken pox. These types of meningitis do not cause the rapid
deterioration as occurs with bacterial meningitis, but there is generally no
effective treatment to eliminate viral infections.
* Fungal meningitis: This is caused by fungi like Cryptococus, usually in
immune-compromised patients, such as those with HIV infection, diabetes, etc.
Fungal meningitis is treatable.
How do we get meningitis?
Bacteria and viruses are found everywhere in the environment, in our
digestive systems, on objects we come into contact with and in the air we
breathe. In general our immune systems keep control of the bacteria so that
they do not invade the body to cause illness.
However situations occur when our tissues are vulnerable and the bacteria or
viruses are able to overcome our resistance to cause illness. Eating healthy
food, and staying away from smoking and excessive drinking are effective ways
to maintain high degrees of resistance. However, even when living healthy
lifestyles, infections can occur.
What are the symptoms of meningitis?
In adults and older children, like with many infections, people feel unwell,
and have fever. One suspects meningitis when, in addition, this is associated
with:
* Severe headache
* Nausea and vomiting
* Photophobia (when one cannot tolerate any light)
* Neck stiffness
It needs to be noted that infections of the throat and ears can cause
similar illnesses, and it is important that people are examined to establish an
underlying cause of the symptoms.
In untreated cases of meningitis, this can go onto confusion, convulsions,
loss of consciousness and skin rashes and bruising.
For younger children (less than two years of age), diagnosing meningitis can
be difficult, as they have symptoms of any infection, including:
* Fever
* Irritability
* Drowsiness and the child is generally unwell
* Refusing to eat and drink
* Continuous crying
* Neck stiffness
How is the diagnosis of meningitis confirmed?
A sample of the cerebro-spinal fluid is obtained by inserting a needle
between the spaces of the spine and through the meninges.
The fluid is examined for evidence of infection and is cultured to grow the
invading organism.
This provides guidance to institute appropriate treatment.
What is the provincial trend of meningitis?
Meningitis cases are seen throughout the year round. The Gauteng Department
of Health (GDoH) keeps record of all meningococcal meningitis cases as it is
the most serious of the bacterial meningitis and can cause death.
The profile of meningococcal meningitis for the past three years in Gauteng
is as follows:
Year: 2006
Number of confirmed meningococcal cases: 171
Number of confirmed deaths: 27
Year: 2007
Number of confirmed meningococcal cases: 200
Number of confirmed deaths: 15
Year: 2008
Number of confirmed meningococcal cases: 53
Number of confirmed deaths: 9
Detailed account of meningitis deaths (suspected) in the province.
Age: 15
Suburb: Mondeor
Date of death: 17 February 2009
Details of case: Developed headache and fever on 16 February 2009. Went to two
clinics where she was treated but did not get better. Referred to Lenmed
Hospital where she died later. Cause of death was confirmed as meningococcal
meningitis.
Medication (chemo-prophylaxis) was provided to closest contacts at school
and home and health education was offered.
Age: 9
Suburb: Senaone, Soweto
Date of death: 20 February 2009
Details of case: Had recurrent headache and fever for three years. On 18
February 2009 she developed fever and a headache. This got worse and her
parents took her to Chiawelo Community Health Centre (CHC) on 20 February 2009
where she collapsed on consultation.
She was immediately referred to Chris Hani Baragwanath Hospital, where she
was declared brain dead on arrival, however doctors continued with support
therapy. Support therapy was discontinued when it was considered to be futile.
Meningococcal meningitis was ruled out when the culture of the cerebro-spinal
fluid grew a gram negative bacillus.
Medication (chemo-prophylaxis) was therefore not provided, but health
education was carried out at the school and for the family.
Age: 15
Suburb: Eldorado Park
Date of death: 4 March 2009
Details of case: Developed sudden headache at school on 3 February 2009 and was
sent home. Headache got worse with associated fever, diarrhoea and skin rashes.
She stopped breathing in the early hours of 4 February. Nevertheless, parents
still rushed her to hospital, where she was declared dead on arrival.
Cause of death could not be confirmed since no tests were done due to family
religious belief requiring the burial to be conducted before sunset. The signs
and symptoms were though suggestive of meningitis.
Medication (chemo-prophylaxis) was therefore provided and health education
was offered.
Age: 10
Suburb: Eldorado Park
Date of death: 7 March 2009
Details of case: Started as lethargy and sleepiness on 6 March 2009. Was taken
to a General Practitioner (GP) on the same day but continued to deteriorate. On
the next day she was referred to Milpark Hospital when she started developing a
fever, diarrhoea and vomiting. Was stabilised and referred to Garden City
Clinic on 7 March 2009. Her condition suddenly worsened at Garden City Clinic
where she passed away within minutes.
There were no signs to suggest meningitis. A post mortem is scheduled for 10
March 2009 for final confirmation.
Issued by: Department of Health, Gauteng Provincial Government
14 March 2009
Source: Gauteng Provincial Government (http://www.health.gpg.gov.za)
