AN INSIGHT INTO THE CEREBROSPINAL MENINGITIS DISEASE - INSPIRED AFTER A RECENT OUTBREAK IN NIGER STATE. NIGERIA

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It was sad listening to the news yesterday when it was announced that over 30 people have died due to the Cerebrospinal meningitis outbreak in Niger state, Nigeria. I was moved at the sight of the bad health state of the victims who are under treatment and those laid to rest. This immediately moved me to research about this deadly disease and I will be sharing with you an insight into the deadly disease - Cerebrospinal meningitis (CSM). Stay with me

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CSM

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WHAT IS MENINGITIS

Meningitis is defined to be the acute inflammation of the meninges which is a collective name for the protective membranes covering the brain and spinal cord. It is a lethal disease that needs emergency medical attention. According to WHO, about 10 -15 % of patients diagnosed with CSM die 1.

It is caused either by bacteria, fungi, virus or chemicals. Its major symptoms include sudden fever, headache, Vomiting, Photophobia, neck stiffness amongst others. It is transmittable and is capable of being highly epidemic.

CAUSATIVE MICROORGANISM OF MENINGITIS

Typically, meningitis is caused by microorganism infection. Most of its infections are caused majorly by either:

• Bacteria,
• Virus,
• Fungi, or
• Parasites

The most severe and the second most common type of meningitis is bacterial meningitis. It has accounted for a lot of death records and high rate of an outbreak. The bacterias that cause Bacterial meningitis ( which the cerebrospinal meningitis is a form) are as follows:

• Streptococcus pneumonia
• Group B Streptococcus
• Neisseria meningitides
• Haemophilus influenza
• Listeria monocytogenes.

The kind of causing bacterial also depends on the age group with the Listeria monocytogenes and the Group B Streptococcus bacteria mostly associated with infants. The Streptococcus pneumonia and the Neisseria meningitides is mostly associated with older children. Adults are usually plagued by the Neisseria meningitides bacteria.

MODE OF TRANSMISSION

Meningitis is a contagious disease – especially the bacterial and viral type. It can be transmitted through respiratory release from an infected person. It could be through coughing, sneezing or close contact like kissing where one’s saliva could mix with that of the infected person.

It is worth saying that some people might just be a carrier of the causative bacteria and might not be actually sick themselves. So, they might not carry any of the symptoms and could still spread the disease.

SIGNS AND SYMPTOMS OF CEREBROSPINAL MENINGITIS (CSM)

This deadly disease could be noticed differently in different age groups. Babies and infants are more likely to get infected even though there is no age exception. In adults, the major signs and symptoms of CSM include:

• Sudden high fever
• Vomiting and Nausea
• A severe Headache
• Altered mental status
• Photophobia
• Nuchal rigidity (neck stiffness)
• Phonophobia

While in babies or infants, these symptoms might not be noticeable. They are more likely to display the following;

• Feed poorly
• Vomit
• Appear pale
• Acting slowly and sometimes inactive
• Bulging fontanelle (soft spot on infant’s head)
• Become Irritated
• Abnormal reflexes

DIAGNOSIS

Initial diagnosis of CSM is usually made by clinical examination of the blood sample. This then followed by analysis of the cerebrospinal fluid through a lumbar puncture. This involves inserting a needing into the durac sac found around the spinal cord so as to collect the cerebrospinal fluid to be analyzed. Under microscopic view, the cerebrospinal fluid is then examined and checked for the presence or growth of any causative bacteria.

TREATMENT

Being a deadly disease, it demands immediate treatment right after the diagnosis of the lumbar puncture procedure – even though some empirical antibiotic can be administered prior to this. It should at every time be treated as an emergency cause. In treating it, antibiotics should be administered with utmost urgency. Common antibiotics that could be administered include penicillin, chloramphenicol, ampicillin, and ceftriaxone.

Along with antibiotics, the use of steroids is also effective as a supplement. They help suppress the effects of the disease.

PREVENTION

The most effective and the best-recommended way of preventing CSM is through vaccination. Due to its lethal effects, many countries over the years have included vaccination for the causative microorganism in the childhood immunization schemes so as to prevent it from childhood. There are several vaccines are available for its prevention. We have the polysaccharide vaccines which are capable of preventing the disease for over 30 years. The Meningococcal polysaccharide vaccines are also available. They exist as either bivalent, trivalent or tetravalent form. The conjugate meningococcal vaccines are also available.

Some short-term antibiotic prophylaxis is also applicable for prevention in some CSM cases and can help reduce the risk of contracting the disease.

ENVIRONMENTAL CAUSES

Basically, the CSM disease is catalyzed by some environmental conditions. Some of these include:

• Climate condition
• Overcrowding
• Poor ventilation
• Socioeconomic factors etc.

The spread of CSM is higher during the winter as compared to summer. During this time, people are susceptible to coughs and sneezing and promotes the release of respiratory secretion which is a mode of transmission of CSM.

Overcrowding also contributes greatly to the spread of CSM as people are usually in close contact and there is usually less ventilation in such scenario. Low standard of living and poor hygiene also contributes to its spread.

EPIDEMIOLOGY OF CSM IN NIGERIA

Nigeria has a history of CSM outbreak. Over the years, dated back to the 90’s till present, over 12,000 deaths have been recorded in line with the CSM outbreak in the country. This is usually traced to the fact that it falls within the region of Sub-Saharan Africa called the “Meningitis belt” where large epidemics occur.

A report from NCDC shows that from September 1, 2017, to January 25, 2018, a total of 481 suspected cases have been reported from twelve States with about 77.9% tested to be positive for bacterial meningitis.

It was the recent outbreak in Niger state that has been causing havoc in the country with over 15 cases recorded daily. It is indeed a sad happening and we pray God ease the suffering

REFERENCES
You can follow the links below to get more information about CSM and its recent outbreak in Nigeria:

http://www.who.int/en/
https://www.vanguardngr.com/2017/04/meningitis-every-nigerian-know/
https://www.vanguardngr.com/2017/04/meningitis-every-nigerian-know/
https://guardian.ng/features/understanding-cerebrospinal-meningitis/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949934/
https://en.wikipedia.org/wiki/Meningitis#Prevention
https://duhs.ucc.edu.gh/notice/meningitis-csm

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Thanks for reading. I hope you find it helpful

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