That fever could be meningitis

MENINGITIS is a disease that has remained a major public health challenge, as its devastating effects have been undeniable, especially in the sub-Saharan region.

A variety of organisms including different bacteria, fungi or viruses, can cause meningitis but the highest global burden is seen with bacterial meningitis. Meningococcal meningitis is a bacteria form of meningitis and a serious infection of the meninges, the brain cover. It can also cause severe brain damage and it is fatal in 10 to 25 per cent of cases if untreated.

With high incidence of the anomaly in northern Nigeria, meningococcal diseases are 1000 to 100,000 times higher than in industrialized nations and the record of mortality is currently on the increase.

The World Health Organisation, WHO, explained that meningococcal meningitis is caused by Neisseria meningitides bacteria and that it is a fatal infection of the thin lining that covers the brain and spinal cord.

Meningococcal meningitis, caused by Neisseria meningitidis bacteria, is of particular importance due to its potential to cause large epidemics. Twelve types of N. meningitides, called serogroups, have been identified, six of which (A, B, C, W, X and Y) can cause epidemics.

“The highest burden of the disease is in the meningitis belt of sub-Saharan Africa, stretching from Senegal in the west to Ethiopia in the east. Around 30, 000 cases are still reported each year from that area. Meningococcal meningitis is associated with high fatality (up to 50 per cent. When untreated) and high frequency (more than 10 per cent) of severe sequela,” the WHO reported.

Further studies have revealed that in 2015, meningitis occurred in about 8.7 million people. Reports recorded that it had resulted in 379,000 deaths from 464,000 deaths in 1990 but currently, appropriate treatment has reduced the mortality rate in bacterial meningitis to less than 15 per cent.

However, a recent report in the Journal of African Medicine shows that the first episode of invasive meningococcal disease was in Geneva in 1805, while the most severe epidemic of meningococcal meningitis experienced by Africa was in 1996, with more than 150,000 reported cases and 16,000 deaths.

As a result of the global importance of the anomaly, countries and partners have issued calls for a vision and the ambition to develop a global strategy to defeat meningitis by 2030.

The Nigeria Centre for Disease Control, NCDC, reported that three predominant bacteria are responsible for more than 70 per cent cases of bacterial meningitis.

“Neisseria meningitidis, Haemophilus influenza b and Streptococcus pneumonia but neisseria meneingitidis has the potential to cause large epidemics, while small percentage is caused by other bacterial species.”

Reports from NCDC show that the disease can be transmitted through contact with droplets from the nose or throat of an infected person, such as sneezing and coughing. “transmission is facilitated by close and prolonged contact like kissing, smoking, sneezing, coughing and overcrowding.”

An expert, Salisu Abdullahi Balarabe, in his report in the Annals of African Medicine, 2018 edition, explained that the epidemic usually begins during the dry season and subsides during the rainy season. Environmental factors, such as humidity, dust concentrations, and a higher number of respiratory tract infections due to the cold nights were mentioned as possible factors.

“Meningococcal meningitis is prevalent in the northern part of the country and the meningitis belt, because of the hot weather, where the annual rainfall ranges between 300mm and 1100mm,”Dr Ibijoke Campbell, a consultant pediatrician at Oni Memorial Hospital disclosed.

According to Dr Campbell , children are most vulnerable especially infants less than two years of age. They can be infected up to adolescent or teenage years.

A consultant pediatrician at the University College Hospital, Ibadan, Dr Joy Ibeh, explained  meningitis as an infection of the covering of the brain, saying that different types of organisms like viruses, fungi, and tuberculosis can infect the meninges.

Speaking on the risk factors, she disclosed that a weak immunity could also predispose a person to meningitis.

“When a person is immuno-compromised or immuno-suppressed, as a result of certain underlying disease conditions that can cause suppression of the immune system, such an individual could be pre-disposed.  For instance, people with HIV, cancer and also those placed on immune suppressive drugs like steroids.

“Also, sometimes when people have head injury, they may have fractures of a part of the skull. The fracture covers discontinuity in the bone that protects the brain and when such occurs, the infection can have access from outside into the brain,” she noted.

Significantly, Dr Ibeh identified poor immunisation as a potential cause of meningitis in children. “The importance of immunising children is to shield them from disease causing organisms and by the virtue of their age, they are not fully developed and don’t have full complement of immunity like an adult, so immunisation complements. But when a child doesn’t get adequate immunisation, such can be predisposed,” she added.

She said:  “meningococcal meningitis caused by Nisseria meningitides bacteria thrives in hot, overcrowded and poorly ventilated places, homes or slums and that is why the northern areas are largely affected.

“A lot of people in the Northern Nigeria do not believe in immunisation, there are lots of people living in small places over there and poverty level is high. So, periodically, every couple of years, there are outbreaks of meningitis.”

Dr Ibeh disclosed that the symptoms associated with meningitis include convulsion, neck stiffness, fever, loss of consciousness, headache, nausea and vomiting but in younger children,  irritability, poor feeding and inactivity are common

Experts have, however, advised people within the different age groups to maintain good personal hygiene etiquettes.

They maintained that meningitis can be prevented by avoiding overcrowded places, ensuring adequate ventilation in the home, covering the nose and mouth with a disposable tissue when sneezing, coughing or blowing the nose and disposing used tissues promptly into the waste bin. Washing of hands frequently with soap and water was also advised.

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