BACTERIAL MENINGITIS

My heart goes out to the family of the 19-year-old Krista Depew, the Argyle, New York student-athlete and valedictorian who died of meningitis. The death of a child is a tragedy none of us should ever have to face. No words can express what they must feel or what we can say to them.

Bacterial meningitis such as this student had, is an infection of the membrane surrounding the brain and spinal cord. The bacteria enter the body through the nasopharynx, move into the bloodstream, and finally cross the blood brain barrier to infect the cerebral spinal fluid (CSF). At each stage, the bacteria must overcome our body’s defenses. breaking down immunoglobin A in the nasalpharynx, passing across the epithelium, evading the white cells and complement in our bloodstream, until finally attacking the meninges. Once they have infected the meninges and invaded the CSF, a cascade of inflammation and toxin release occurs which can lead to vascular injury, lack of oxygen, lack of glucose, possible brain edema, and long term neurologic impairment or even death.

Meningitis usually presents with a fever, but not always. Signs to note would be headache, nausea, vomiting, irritability, and lack of appetite. The patient may be confused or have other mental status changes, have a severe aversion to light, and may experience back pain or a stiff neck. Having any one of these signs does not mean a person has meningitis and can be indicators of other disease. But, the more symptoms or the more severe any one symptom the more important it is to be evaluated by your practitioner. Bacterial Meningitis is a medical emergency, treated in hospital with antibiotics, steroids, and supportive care.

The incidence of meningitis in the US has declined due to the use of specific immunizations. The 3 major pathogens were Haemophilus Influenza, Strep Pneumo, and Neisseria Meningitidis (this last was the cause of the recent death).  In the under 5 year old group, H flu caused 23 cases of meningitis per 100,000 children, after using the vaccine there are 3 cases per 1,000,000. For strep pneumo, in the under 2yr old population, there were 188 cases per 100,000 children pre vaccine with 59 cases per 100,000 after starting the vaccine. For neisseria menigitidis, in the under 17 yr old there were 74 cases per 100,000 children pre vaccine and 1. 4 cases after using the vaccine. The vaccines work for specific types of each bacteria. For Strep Pneumo, the vaccine was changed due to the rise of other strep pneumo types that previously were not major causes of disease.  The new vaccine targets 13 different family members and should lead to another reduction in disease incidence. The neisseria vaccine covers 4 types of this bacteria A, C, Y, and W135. This young lady unfortunately died of type B, which is not covered by this vaccine.

Our immunization program does not cover every single pathogen. Even though the Neisseria Meningitidis vaccine Menactra is commonly called the meningitis shot, it does not prevent every type of meningitis. It substantially reduces the incidence of disease but does not eliminate it. We have made great strides against meningitis, with the median age in 1988 being 6 months of age, to now the median age is in the mid twenties, all subsequent to the use of targeted immunizations.

Even with appropriate treatment, meningitis can lead to death or long term  neurologic impairment especially hearing loss. We must continue to vaccinate, and be vigilant against the possibility of this rare but so serious disorder.

-Dr. Michael Looney