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THE CONSERVATORY OF MEDICAL ARTS AND SCIENCES
XVII
THE SEARCHLIGHT MESSENGER
THE SEARCHLIGHT MESSENGER
Blog
The Killer On Campus
| Posted on August 30, 2013 at 11:02 PM |
Many in my readership have seen my
previous articles on Meningitis, and again, it's that time of year, when
every August, I write an article on this important subject. This year my
article will be accompanied by a discussion regarding the state of the art in
the management of this disease. Although
there are many organisms that can induce meningitis, a crippling and often
fatal disease, from parasites and bacteria, to viruses, and even fungi as was
seen in the tainted steroid vials from the New England Compounding Center
just this last year, the Meningococcal bacterium is relentless in its attack
once it invades. A serious pathogen with weaponry that is both efficient, and
nearly impossible to repel. College
students, whether returning to school or just starting this fall, should be
warned, and remember that there is a killer loose on campus. Its name is Neisseria
Meningitidis, also known as the Meningococcus. Yes, it causes
meningitis, but this is just one of the specters of disease this killer
brings. It is vicious and unwavering in its ability to take down even the
most robust human. It can attack at multiple levels affecting multiple
systems, taking in some cases, only hours from initial infection to coma and
death. Nothing, it seems is spared. From stroke to cardiogenic shock and
renal failure, it can kill before meningitis even gets a chance to set up
shop.  Although
rare in the United States, it has caused epidemics in the United Kingdom and
New Zealand, and is obviously an organism to be reckoned with. In addition to
striking small children, it likes to attack robust men and women in their upper
teens and early twenties. That's right, college students. And when it
strikes, you feel like you have the flu; a few hours later, you are septic;
in a few more, you are in septic shock. When the inflammation of the
meningeal covering around your brain and spinal cord begins (meningitis),
it’s too late, and “you will find yourself alone in green pastures with the
sun on your face, because you are in Elysium, and you are already dead!" Imagine
a college athlete at age 20 with everything going for him; a great school,
academic success, strength and quickness, a full ride scholarship,
popularity, and a life style envied by everyone. Then one October morning, he
wakes up chilled, notices a mild fever, and he has a sore throat. He thinks
“he’s caught a cold”, takes the usual remedies, and doesn’t tell anyone he’s
“under the weather today”, because, “it’s just a cold”, and all he needs is
rest. The next morning, he is found dead in his dorm room by his team mates.
They notice reddish-black “splotches” all over his body.  Unfortunately,
this is the rule and not the exception in a meningococcal attack. Small children
are done in by this predator even more quickly. It invades through intimate
contact usually, but can be acquired from casual contact as well. The really
bad thing with this organism, is its deliberate swiftness. Moreover, the
agonizing death of shock and accompanying meningeal “tightening” which is
brutally painful, and described by survivors, as the most agonizing torture
they have every been through. Many say they would rather die than go through
it again.
Survivors
usually lose limbs, go blind, develop renal failure, suffer heart attacks or
strokes due to ischemia and dissolved blood vessels. The Meningococcus
is a deliberate killer with no apparent goal except to take down its host
rapidly. Scientists are always perplexed by infectious diseases like this
one, which attack, then kill their host and themselves so quickly in the
process. What’s
happening? This organism secretes an endotoxin that attacks macrophages
(white cells, whose job is to search and destroy invaders), creating
circulating cellular debris, at the same time, eating away the intimal lining
of our blood vessels, creating an immune reaction of cytokines. This is why
many victims have severe petechiae and bruising almost immediately after
infection, and of course, the reason the victim succumbs so swiftly. We
can kill this organism with antibiotics. He has never been one to show
resistance to our antibiotic weaponry. The problem is that when the organism
breaks down from penicillin or any other antibiotic we use, huge quantities
of this endotoxin are released, the condition of the patient is exacerbated
exponentially, and we gain nothing. The victims die outright or they are left
crippled. There is no real treatment for an acute attack, but there is a
vaccine! It is our only true and effective weapon right now, and yes, it works
very well. Do yourself and others a favor and get the meningococcal
vaccine. Realize that most schools require it now, before you start
college. Keep
in mind that this is a stealthy organism. Fifteen to twenty percent of Americans
are carriers. That means two out of every ten people you brush by, are
harboring this organism without it causing illness to them, but they can
infect you. It can be transmitted by sharing a cup or straw. Yes you can
catch it from a casual kiss as well as sexual activity. Use your head, and
keep your hands clean.  Remember,
meningitis in general, can be caused by a host of different organisms and
viruses, and although the meningococcus has a scary reputation, it is
a smaller player in this regard. For example, the organism we worry about the
most, and the number one cause of meningitis in children under two years of
age in North America, is Haemophilus Influenza (H. Flu.). Also a well known
killer, we can take it down with antibiotics if caught in time.
Unfortunately, survivors are usually left deaf. This is why we vaccinate
against H. Flu. Also known as the HIB vaccine, it is required by all
fifty of the United States. The recent Listeria scare is also a concern. Listeria
Monocytogenes, although a well known food poisoner and one of the reasons
we pasteurize all of our dairy products in the U.S., it is also known for
causing meningitis in little ones, especially infants. Do
yourself a big favor, and get the vaccine before heading back to school this
fall, it’s never too late. Get it now! If your doctor doesn't offer it, any
county health department will have it.
Do the right thing. Make sure all of your vaccines are up to
date, including the meningococcal vaccine. And don’t forget to keep your
hands clean. Just
this month (August, 2013), the US Food and Drug Administration (FDA)
broadened the indication for the quadrivalent meningococcal vaccine (Menveo;
Novartis Pharmaceuticals, Inc) to include infants and toddlers aged 2 months
and older. The vaccine, which protects against the common N meningitidis
serogroups: A, C, Y, and W-135, was already approved for use in adolescents
and adults aged 11-55 years and in children aged 2-10 years. Below,
is my discussion regarding Neisseria Meningitidis Meningitis and our latest
in the standard of patient care in the specialties of Internal Medicine and
Pediatrics here in North America and Great Britain.  Dr. Counce The Conservatory is followed worldwide. See the National Flags of Our Top Twelve users. Discussion and Management of Meningitis By Dr. C. M. Counce Signs and symptoms of Meningitis Meningococcal
meningitis is characterized by acute onset of the following:
 Don’t
forget the general presentation of catarrhal symptoms alone, prior to the
presentation of meningeal irritation as noted above.
Lethargy
or drowsiness in patients frequently is reported. Stupor or coma is less
common. If coma is present, the prognosis is obviously poor. Patients
also may complain of skin rash, which usually points to disease progression,
and an indication that the cytokine storm has begun. Elderly patients are
prone to have an altered mental state and a protracted course with fever.
Meningococcal
septicemia, which is characterized by rapid circulatory collapse and hemorrhagic
rash, is a more severe, but less common, form of meningococcal disease as
patients are now presenting sooner to our emergency departments.
Young
children In
young children, subacute infection can progress over several days. Meningococcal meningitis can manifest as follows:
In
children, even when the combination of status epilepticus and fever exists,
the classic signs and symptoms of acute bacterial meningitis may not be
present.
Physical Examination Neurologic signs of
meningococcal meningitis include nuchal rigidity (eg, Kernig sign, Brudzinski
sign), lethargy, delirium, coma, and seizures.
Irritability is a common
presenting feature in children.
However, in a 2008 published
cohort study from Netherlands (the Meningitis Cohort Study), conducted in
adult patients with meningococcal meningitis, only 70% of the patients had
the classic triad of fever, neck stiffness, and change in mental status. If
the presence of rash was added, 89% of the patients had 2 of the 4 features.
Patients older than 30 years
were noted to have petechiae (62%) less frequently than younger patients
(81%).   A petechial or purpuric rash
usually is found on the trunk, legs, mucous membranes, and conjunctivae.
Occasionally, it is on the palms and soles. The rash may progress to purpura
fulminans, when it usually is associated with multiorgan failure (ie,
Waterhouse-Friderichsen syndrome). The petechial rash may be difficult to
recognize in dark-skinned patients.
 Ancillary StudiesLaboratory
studies Laboratory
examination of the cerebrospinal fluid (CSF) usually confirms the presence of
meningitis. Typical CSF abnormalities in meningitis include the following:
Other
laboratory tests can include the following:
Imaging
studies
Electroencephalography An
electroencephalogram (EEG) study is sometimes useful to document irritable
electrical patterns that may predispose the patient to seizures.
Management To
prevent serious neurologic morbidity and death, prompt institution of
antibiotic therapy is essential when the diagnosis of bacterial meningitis is
suspected. Antimicrobial treatment should be administered as soon as possible
after a lumbar puncture is performed.
Empiric
pharmacologic therapy Initial
empiric therapy until the etiology of the meningitis is established should
include the following agents:
Postdiagnosis
pharmacologic therapy
Prophylaxis Deterrence
and prevention of meningococcal meningitis can be achieved by either
immunoprophylaxis or chemoprophylaxis. Rifampin, quinolones, and ceftriaxone
are the antimicrobials that are used to eradicate meningococci from the
nasopharynx.
Currently,
vaccinations against meningococcus A, C, W, and Y are available. No effective
vaccine exists to protect individuals from meningococcal meningitis caused by
serogroup B. Interesting,
in that serogroup B is the mainstream killer in countries with higher
prevalence of this disease (The United Kingdom and New Zealand).
Dr.
Counce |
Categories: Medical Advise
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This is why we vaccinate against H. Flu. Also known as the HIB vaccine, it is required by all fifty of the United States.
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