Meningococcal vaccines urged

By SHARON CHAYRA

VIEW ON HEALTH

They were the frightening symptoms all too familiar for 44-year-old Las Vegas entertainer, Robert Nash. The excruciating headache that started from the base of his neck. Raging fever. Cold sweats. Overwhelming fatigue that nearly drowned out the pain of the headache but didn't.

"I kept thinking to myself, oh please God don't let this be meningitis," says Nash who had good reason to fear this potentially fatal disease. "I mean, who gets meningitis three times in their life in a span of ten years? Even the doctors say that's highly unusual."

Meningitis is a meningococcal disease with viral and bacterial varieties. The number of cases changes from year to year nationwide. From 1998 to 2007, about 1,500 Americans were infected each year. Eleven percent of those infected with meningitis will die. One out of seven cases among adolescents will result in death.

As Senior Epidemiologist for the Southern Nevada Health District, Brian Labus and his team monitor infectious diseases like meningitis. "We are most concerned about meningococcal meningitis as it's the most serious. This is the bacterial variety with a rapid onset and can cause death although most people survive."

In basic terms, meningitis is an inflammation of the membranes and cerebrospinal fluid surrounding the brain and spinal cord, usually due to the spread of an infection. The swelling associated with meningitis often triggers the trademark symptoms of this condition, including headache, fever and a stiff neck.

Both bacteria and viruses cause meningitis. Depending on the cause of the infection, meningitis can resolve on its own in a couple of weeks or it can be a life-threatening emergency.

When any virus causes meningitis, the result is viral meningitis. The term is usually used for specific viruses that cause a mild meningitis and no other symptoms or diseases. Viral meningitis is quite common and usually does not result in severe illness when compared to most bacterial meningitis. Some physicians call viral meningitis aseptic meningitis because bacteria do not grow in the spinal fluid. When they know the patient has meningitis but do not know the cause or cannot identify a bacteria, they say that it is aseptic.

For Nash, his latest experience with meningitis was met with a two-week hospital stay and treatment including IV antibiotics because the cause was unknown.

Labus notes, "Both infectious disease specialists and ER docs see the majority of meningitis cases. Because time is of the essence, a patient is treated with antibiotics immediately until the cultures from the spinal tap are available.aIn addition to how a patient presents, blood testing for inflammation such as C-reactive proteins, meningitis is primarily diagnosed by spinal tap results. A spinal tap or lumbar puncture is when the doctor inserts a thin needle into the spinal cord area and extracts cerebrospinal fluid or CSF for examination under a microscope. The fluid is then cultured to determine if it's affected by a virus or bacteria. Sometimes results can be inconclusive but levels of glucose or sugar and proteins will indicate whether the disease is viral or bacterial in origin. Labus says, "Bacteria grow on sugar and when the bacteria die, they leave higher protein levels. Virus don't need sugar so glucose levels are normal or slightly elevated, whereas white blood cells are much higher in bacterial meningitis."

Bacterial meningitis is commonly spread by direct contact with infected feces or nose and throat secretions. Common activities like kissing, sharing a drinking glass or living in close proximity can spread meningococcal meningitis. This is the primary reason that some universities, colleges and military have policies requiring students or enlisted to receive the meningococcal vaccine. Labus points out, however, that the vaccine does not cover all of the strains of meningococcal disease so it is not a 100 percent guarantee to prevent the disease.

Viruses that can cause meningitis include the same viruses that include chickenpox, mumps, shingles and HIV. Non-infectious meningitis can result from cancer, chronic inflammatory diseases like lupus and sarcoidosis, antibiotics as well as non-steroidal anti-inflammatory drugs.

Most children carry the meningitis virus without becoming ill. Enteroviruses are the usual cause. These are the viruses that only infect human beings and are spread by the fecal-oral route. They live in the human intestine.

Viral meningitis typically starts suddenly. Babies may have a more gradual illness such as a refusal to eat, sleepier than usual, and fussy. Babies younger than 18 months may develop a rigid or tender back and extreme fussiness that cannot be consoled. Bulging fontanels or the baby's "soft spot," occurs less in viral meningitis and, if it does, is usually a late sign.

Some viral meningitis results in a rash that may cover most of the body or just the arms and the legs. The rash is red and flat, though it may be raised in some areas. It is not the same as the rash in meningococcal meningitis, which is small, with pinpoint bright red spots covering most of the body. Enterovirus meningitis may also cause a sore throat and conjunctivitis.

Most children and adults usually recover completely within 10 to 14 days. A few children have a long convalescence from viral meningitis. They may have muscle weakness, tiredness, headaches, muscle spasms, insomnia or personality changes such as behavioral problems and the inability to concentrate. These are rarely permanent, but may take a few weeks to a few months to disappear.

There is no treatment for viral meningitis. The immune system however, will produce antibodies to destroy the virus. Until it is known that a child has viral, not bacterial meningitis, he or she will be admitted to the hospital. But once the diagnosis of viral meningitis is made, antibiotics are stopped, and a child who is recovering well will be sent home.

Only acetaminophen should be given to reduce fevers. Clear fluids and a bland diet including favorite foods should be offered. During recovery, a person needs rest in a darkened, quiet room. Bright lights, noise and visitors may irritate a child with meningitis.

Bacterial meningitis, on the other hand, is much more serious. Fortunately, says Labus, viral meningitis is outpaced three-to-one by bacterial meningitis.

Bacterial meningitis can cause severe disease that can result in brain damage, the amputation of limbs and even death. Bacterial meningitis is most commonly caused by one of three types of bacteria: Haemophilus influenzae type b (Hib), Neisseria meningitidis, and Streptococcus pneumoniae. Before the 1990s, Hib was the leading cause of bacterial meningitis, but new vaccines being given to children as part of their routine immunizations have reduced the occurrence of serious Hib disease.

Today, Neisseria meningitidis and Streptococcus pneumoniae are the leading causes of bacterial meningitis. Meningitis caused by Neisseria meningitidis is also called meningococcal meningitis. Meningitis caused by Streptococcus pneumoniae is called pneumococcal meningitis.

Bacterial meningitis is so dangerous because it is found worldwide. There are approximately 25,000 cases of bacterial meningitis annually in USA. The bacteria often live harmlessly in a person's mouth and throat. In rare instances, however, they can break through the body's immune defenses and travel to the fluid surrounding the brain and spinal cord. There they begin to multiply quickly. Soon, the thin membrane that covers the brain and spinal cord becomes swollen and inflamed, leading to the classic symptoms of meningitis.

The bacteria are spread by direct close contact with the discharges from the nose or throat of an infected person. Fortunately, none of the bacteria that cause meningitis are very contagious, and they are not spread by casual contact or by simply breathing the air where a person with meningitis has been.

Common symptoms of bacterial meningitis are high fever, headache, and stiff neck. These symptoms can develop over several hours, or they may take one to two days. Other symptoms can include nausea, vomiting, sensitivity to light, confusion, and sleepiness. In an advanced stage of the disease, bruises develop under the skin and spread quickly.

In newborns and infants, the typical symptoms of fever, headache, and neck stiffness may be hard to detect. Other signs in babies might be inactivity, irritability, vomiting, and poor feeding. As the disease progresses, patients of any age can have seizures.

Another reason bacterial meningitis is so dangerous is that anyone can get bacterial meningitis. However it is most common in infants and children. People who have had close or prolonged contact with a patient with meningitis caused by neisseria meningitidis or Hib can also be at increased risk. This includes people in the same household or day-care center, or anyone with direct contact with discharges from a meningitis patient's mouth or nose.

Without knowing how he got three bouts of meningitis in a span of a decade, Robert Nash jokes in one of his many impersonation voices that he feels like he's become a bit of a Howard Hughes--the magnet recluse whose attempts to stave off germs in his later years earned him a "paranoid" reputation.

"I carry hand-sanitizer, avoid sick people which can be tough when you're performing in big groups and cover my face or walk away from a sneezing person. I also wash my hands. A lot."