Epidemic Meningococcal meningitis

• ¹Gombe State University, Gombe, Department of Internal Medicine, Gombe State University, Gombe, Nigeria. , NG

Abstract

Neisseria meningitides, the major causative agent of bacterial meningitis was first identified and described by Vieusseux in 1805, before which time little was known about the disease. The disease was often fatal as there was no effective therapy at the time. Little was known about its pathophysiology, and severe disease was almost uniformly fatal, particularly when complications such as meningococcaemia developed. Endemic disease occurs nearly all the time, often causing only mild to moderate symptoms, but epidemic disease, identified later, has been a major public health concern, particularly in resource-poor countries. Once the causative organism was identified, a number of interventions were tried with variable degrees of success, among them chemotherapy and chemoprophylaxis with sulphonamides and other sulpha drugs, and penicillin. The introduction of sulphonamides for treatment of meningococcal meningitis (otherwise known as cerebrospinal meningitis, CSM) was a defining moment, as described by Kirk in 1950. The drug came in tablet form known popularly as M and B (made by May and Baker) so administration was problematic; initially, the tablets had to be crushed and administered parenterally in divided doses, which was a problem in Africa. However, sulphonamides reduced mortality from about 80% to 10%. Despite their success in reducing morbidity and mortality, these chemotherapeutic agents did not prevent epidemics from occurring periodically. Epidemics used to occur infrequently, but became more regular, occurring every five to ten years in the African meningitis belt, due largely to increasing resistance of meningococci to sulphonamides. Other causative agents of meningitis include Streptococcus Pneumoniae, Haemophilus influenza type b and Mycobacterium tuberculosis. This review will concentrate, in the main, on epidemic meningococcal disease with particular emphasis on Nigeria. Sporadic cases of meningitis are seen throughout the year, and in every continent, but severity of the infection varies from region to region. The factors that influence severity of disease are complex, but as a general guide these include nutritional status and competence of the immune system. The symptoms of meningitis are generally well known: fever (often high), backache and neck-ache both accompanied by stiffness, photophobia and generalized malaise. The onset is sometimes insidious but may be abrupt, beginning as a ‘flu-like’ illness. Vomiting may be a feature in some patients and a characteristic skin rash may be the first symptom, the latter believed by some scientists as evidence of immune complex deposition. Diarrhoea may occur and is sometimes so profuse as to be confused with cholera. The symptoms and complications of the disease are mostly self-limiting, excepting the most severe ones such as stroke, and disappear on successful treatment.