what is meningitis anyway?

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When I read something on the internet or elsewhere  about meningitis, or especially about the "meningitis vaccine" it strikes me that the ubiquitous use of the noun without an appropriate adjective could be confusing for most people. Don't misunderstand me, I am not talking about adjectives like "bad," "awful," or "life-threatening." Rather, I am talking about the adjective that indicates the microbiological etiology of the problem--such as "meningococcal meningitis" or "hemophilus meningitis," or "pneumococcal meningitis," or even "viral meningitis"

Why is this so important? Most of you are NOT pediatric infectious disease specialists, or microbiologists, or probably even health care providers.Why should you care?

It's important because it matters.

It matters because one cannot have a universal vaccine against MENINGITIS. However, there are different vaccines that are effective against many, but not all of the CAUSES of meningitis.

Perhaps a definition of meningitis would help. It is pretty straightforward.

Meningitis is an inflammation (-itis) of the membranes(meninges) that line the central nervous system, which is made up of the brain, brainstem and spinal cord. The inflammation is generally due to white blood cells (WBCs) accumulating around the brain and/or spinal cord. The WBCs are called into action when they are faced with an infectious organism that the body is trying to get rid of. Generally WBCs are good to have on hand to fight infection, but when they get into an area that cannot easily expand, they cause swelling. If the swelling is in your leg or your lung, generally the tissue around it can expand, and is tolerated fairly well. However, swelling inside the brain has nowhere to go, so it ends up squishing parts of the brain itself, which accounts for the kinds of complications we often see from meningitis.

I have written here previously about the honor I had to work on a vaccine against the organism hemophilus influenzae type b. That is quite a mouthful, so it is usually just called "Hib." When I was in medical school, and during my pediatric residency, Hib was the single most common cause of meningitis in children under the age of 5. It caused all sorts of badness; leaving the survivors deaf or blind or cognitively impaired.  It has nearly disappeared, yet we still have stories about people contracting MENINGITIS--why?.

And why is the Hib vaccine not called a meningitis vaccine?

The "MENINGITIS VACCINE" is actually a vaccine against strains of an organism called Neisseria meningitidis (often just referred to as meningococcus). This bacterium is often the culprit responsible for meningitis outbreaks among college students and military recruits, although this has decreased of late due to the efforts to achieve widespread immunization of vulnerable populations. It is the organism most often responsible if you hear a story about someone who developed a fever, thought they had the flu, developed a horrible headache, and a rash that quickly spread over their body. This organism is notorious for causing such major problems with blood flow getting to someone's limbs that the hands and feet, or arms and legs may end up necrotic, and need to be amputated.

Ick!! Yes, this is a bad actor among bad actors.

If there is one bacterial name you don't want to hear in relation to your own or a family member's health, that is the one (of course there are others you would prefer not to come in contact with, but we will leave those for another day.

I will tell you a personal story, of an experience I had with this organism that I will never forget.

I was a second year resident on call in the Emergency Department. There were no attending physicians present on the over night shift--that was common in those days, but not now. About 7:30 am I received a call from a local pediatrician, very concerned about a child he was seeing in his office, who came in for a sick visit during his early morning walk-in hours, because of a fever and rash that began the night before. He said the child (about 4 years old) looked "septic" to him. He had a very high fever, and was lethargic to the point of being barely responsive, with a "purpuric" rash covering his body. The two year old brother was also running a fever and was vomiting, and had a similar rash on his hands but was otherwise looking better. The 7 year old brother seemed well, but was running a low grade temp. His office was only 4 or 5 blocks from the ED, so he was sending the family to the ED in their car, and we were ready to meet them at the door, to get some basic blood work off and start antibiotics right away, for "presumed" meningococcal sepsis. The family arrived literally in less than 10 minutes. The 4 year old was dead, the 2 year-old was covered with purple lesions and unable to recognize his mother, and the 7 year old had a high grade temperature, and was complaining of a severe headache.

I was overwhelmed at the rapidity with which this bacterial infection had done its harm.

As I noted, the four year old had died in the ten minutes it took to get him into the car and drive to the ED. It would not have made a difference if they had called an ambulance, since it would have taken at least that long for it to arrive at the physician office. The two-year old was treated immediately with antibiotics and fluids, and admitted to the pediatric intensive care unit. There, despite what was state of the art care at that time, his hands and feet ended up having to be amputated, but he survived. As for the 7-year-old, he became ill, developed somewhat of a rash, but had gotten antibiotics early enough that "all he had" was meningitis. Also, his age may have helped him. He was discharged two weeks later doing fine (except for the emotional trauma of the whole situation and its aftermath).

I could tell you other stories about other children and young adults I have treated with this infection. They are all indelibly etched in my mind. This is the scenario we can prevent with the "meningitis vaccine."

 

It is not ONLY meningitis, and it sometimes doesn't even cause meningitis per se.

 

But it surely is worth preventing, don't you think?

 

I was recently at a conference where a young adult spoke to us about courage and strength. She had lost both lower legs and parts of both hands to this dreaded infectious disease. She is now an avid vaccine advocate. We were so moved that we gave her a standing ovation. I hope I NEVER get to see another case of meningococcemia, but I know I will.

 

Please share your comments and your questions below. There is much more about this disease that we could discuss, but I have to stop somewhere!