Bacterial Meningitis: The Swift, Silent Killer

By Marie Hill

For Advanced Composition, ETSU, Spring 2011

Marie Hill is a senior at East Tennessee State University studying English and Education. She has also been in the medical field for 7 years and is currently a pharmacy IV technician. Throughout all her years in medicine she has never before seen the emotional devastation that she witnessed one week while observing a high school English class.

The parking lot of the high school in Elizabethton, Tennessee was only half full when I pulled in on that rainy and cold March day. As I walked through the cafeteria, on my way to the school office, I noticed many students were absent. Most of the underclassmen didn’t show up for school at all that day and the ones that did were distraught and quiet. The juniors and seniors were more scared than sad and the concerned-looking teachers whispered constantly to one another. The English class that I was observing was very relaxed that day as the teacher did have the heart to press the academic issue. The one thing on everyone’s mind, in the school and in the close-knit Appalachian community, was the freshman boy, who had been there one day and gone the next. His classmates, the four of them that showed up that day, pointed out where he used to sit in their English class -- yet they couldn’t understand why he was no longer there. The teachers offered the students an ear but they had nothing to say. Their silence echoed the deadly silence of the disease that took away their friend.

The Silent Killer

The young man, whom I’ll call Jason for the sake of privacy, died from bacterial meningitis. It is a condition that most would recognize upon hearing, but not many could explain -- a result of its rarity. Meningitis is the inflammation of the meninges which are the membranes that cover and protect the brain and spinal cord. The meninges also create a barrier between the central nervous system and the body’s blood; this barrier is called the blood-brain barrier. Meningitis occurs when the meninges are infected by bacteria, fungi, viruses, or other microorganisms. According to the Center for Disease Control website, the microorganism begins in the bloodstream and then moves on to the meninges where it breaks through via a weak spot. The body’s immune system responds to the invading organism by allowing the meninges to become more permeable. This permits white blood cells and other fluids into the central nervous system to help rid the body of the microorganism. This influx of fluid causes serious inflammation of the membranes surrounding the brain and spinal cord which limits the blood flow to these areas. This lack of blood flow restricts oxygen to the brain which results in severe damage and oftentimes death.

The microorganism which causes the most severe reaction is the bacteria Neisseria meningitidis, also known as meningococcus. Although meningitis can also result from the invasion of fungi, viruses, etc., it is this bacterial form that is the most dangerous. The meningococcus bacteria is a normal inhabitant of the human nasopharynx, the upper part of the pharynx near the nasal cavity, and can reside there without infecting its host. According to Pediatrics: Principles and Practice, a textbook on pediatric medicine, around 15% of the human population are carriers of the bacteria. This number can increase to 30% during an outbreak of meningitis. The bacteria is spread to other individuals by the exchange of saliva and upper respiratory fluids through the acts of kissing, coughing, and the sharing of food and drink. Once the bacteria is passed on, conditions have to be perfect for it to find the weakness in the individual’s meninges and then for it to pass through that barrier. The initial symptoms of infection are slight and may only include fatigue. However, fatigue can rapidly progress to headache and stiff neck and then on to coma and death -- often within 48 hours of infection. Around 3,000 cases of bacterial meningitis are reported annually; 10% of those cases result in death and 1 in 5 survivors of the disease will suffer from permanent damage such as an amputation, hearing loss, scarring, or neurological damage.

Diagram of Meninges: Modern Guide to Health

Diagnosis and Treatment

Diagnosing bacterial meningitis can be extremely difficult. Due to the deadly nature of the disease, when a patient has symptoms resembling those of meningitis, powerful antibiotics are administered immediately in an effort to prevent death. A lumbar puncture can then be performed to test for the presence of the bacteria. Since antibiotics have already been administered the chances are moderate that most of the bacteria will be dead or dying and thence unidentifiable. However, the benefits of early antibiotic administration exceed the desire for definite diagnosis. If the test comes back identifying a specific bacteria, then antibiotics will be given that are tailored towards that particular strain.

The most important factor in treating meningitis is time. The longer someone waits to seek treatment, the poorer the outcome. The rapid progression of the disease requires immediate treatment for the best possible outcome. Antibiotics are usually administered at the first suspicion of meningitis. Antibiotics do not, however, resolve the inflammation caused by the bacteria, which is the deadliest aspect of the disease. It is imperative to control inflammation to avoid brain and neurological damage. If intracranial pressure is high, administration of medication is required to relieve the pressure and to allow blood to flow to the brain and spinal cord. If blood flow is restricted too long then certain brain damage and possible death will result. Steroids can be administered, as well as a drug called Mannitol, both of which aid in the reduction of inflammation. If the disease is caught soon enough, and treated correctly, then full recovery is most likely the end result.

Prevention

Bacterial Meningitis Mortality Rate by Age

So what can you do for protection against bacterial meningitis? The most important thing to consider in the prevention of meningitis is obtaining the meningococcal vaccine. There are several vaccines available, some specifically for children and then those indicated for adolescent and adult use only. The website for Menactra, a vaccine for meningitis, states that vaccination of adolescents against bacterial meningitis is highly recommended due to a decrease in immunity around the teenage years. The vaccine has also become mandatory for many college students living in dormitories due to the cramped living quarters among roommates, which increases the chance for transmitting the disease. The vaccine is not a foolproof guarantee, but it can be the difference between life and death.

There are also precautions that can be taken to help ward off contraction of the disease. Since the bacterium is spread through saliva and respiratory secretions, it is important to avoid drinking and eating after other people. This is especially important to explain to adolescents who tend to believe that their friends and their selves are forever immune to any disease. Covering the mouth when coughing and developing good hand washing habits will also help in warding off meningitis. The close proximity of high school and college students, especially those in dormitories, increases the risk for passing on the bacteria. An individual’s immunity is at an all-time low around adolescence because all of the infant vaccinations have gradually worn off. Immunity then builds back up from exposure to various microorganisms by the age of 25. According to the CDC these factors result in the peak age for contracting bacterial meningitis to be from 15 to 25. Therefore, it is imperative for adolescents to receive immunization which can greatly reduce the chances for contracting the disease.

Psychological Effect

I was off from work that Wednesday evening, relaxing on the couch watching TV, when my cell phone buzzed with a text message. It was my grandmother.

A boy at Elizabethton High died today. They think it was bacterial meningitis.

Horrified, I immediately wondered if he was in the class that I was observing. I pulled up Facebook, the best place to find news, to see if anyone had posted about the incident. They had. Sadly, I recognized the happy, intelligent face that was plastered all over the internet. His “memorial page” already had hundreds of followers.

Jason went home from school with a headache around noon on a Tuesday; his parents told the school that he became unresponsive that evening, and was declared brain-dead by Wednesday morning. The rapidity of the disease, and the lack of what seems to be serious symptoms, is the cause of confusion and fear for those who have seen meningitis’ devastating outcome. It was a shock to the students, and especially Jason’s friends, when they were all ushered into the gymnasium to be told of Jason’s death and of the risk of those close to him contracting the disease. This event set off something of a hysteria in the community as parents were extremely worried about their own children contracting the disease. Many students and teachers were given Rifampin, a strong antibiotic, as a prophylaxis for meningitis. It eased their minds but did not heal their hearts as they mourned for the happy and bright young man whose future was cut tragically short.

Works Cited

Bacterial Meningitis. Center for Disease and Control. 25 March 2011. Web.

Bacterial Meningitis. Oski’s Pediatrics: Principles and Practice. Julian McMillan ed. 25 March 2011. Web. 348-56.

What is the Menactra Vaccine? Website for Menactra, Vaccine for Meningococcal Meningitis. 26 March 2011. Web.