Government of Turkey (Türkiye Burslari) Undergraduate & Postgraduate Scholarships 2020/2021 for study in Turkey (Fully Funded)

OMOGE ADEYEMI OGEDENGBE

300 LEVEL PUBLIC HEALTH

DEPARTMENT OF PUBLIC HEALTH

FACULTY OF BASIC MEDICAL SCIENCES

ADELEKE UNIVERSITY, EDE, OSUN STATE

CEREBROSPINAL MENINGITIS (CSM)

CEREBROSPINAL MENINGITIS (CSM)

INTRODUCTIO

Cerebrospinal Meningitis is inflammation of the meninges. The meninges are the collective name for the three membranes that envelope the brain and spinal cord (central nervous system), called the Dura mater, the Arachnoid mater, and the Pia mater. The meninges main function, alongside the cerebrospinal fluid is to protect the central nervous system. Meningitis is usually caused by a bacterial infection, but it can also be caused by a viral or fungal infection. Depending on the type of infection, meningitis can be easily curable or potentially life threatening. The word "Meningitis" comes from the Latin word “Meninga” and the Greek word “Menix” meaning "Membrane". The suffix "Itis" comes from the Greek word “Itis” meaning “Pertaining to”. In medical English, the suffix "Itis means “Inflammation of”.

CAUSES OF MENINTITIS (CAUSATIVE AGENTS)

Meningitis is generally caused by infection of viruses, bacteria, fungi, parasites, and certain organisms. Anatomical defects or weak immune systems may be linked to recurrent bacterial meningitis. In the majority of cases the cause is a virus. However, some non-infectious causes of meningitis also exist. A study carried out by researchers at the University of Oxford and Imperial College London, England, showed how bacteria that cause bacterial meningitis mimic human cells in order to evade the body's innate immune system.

VIRAL MENINGITIS

Although viral meningitis is the most common, it is rarely a serious infection. It can be caused by a number of different viruses, such as mosquito-borne viruses. There is no specific treatment for this type of meningitis. In the vast majority of cases the illness resolves itself within a week without any complications. Viruses in the Enterovirus category cause 85 percent of cases. These are more common during the summer and fall, and they include:

Coxsackievirus A

Coxsackievirus B

Echoviruses

Viruses in the Enterovirus category cause about 10 to 15 million infections per year, but only a small percentage of people who get infected will develop meningitis. Other viruses can cause meningitis. These include:

West Nile virus

Influenza

Mumps

HIV

Measles

Herpes viruses

Coltivirus, which causes Colorado tick fever

Viral meningitis typically goes away without treatment.

BACTERIAL MENINGITIS

Bacterial meningitis is generally a serious infection. It is caused by three types of bacteria: Haemophilus influenzae type b, Neisseria meningitidis, and Streptococcus pneumoniae bacteria. Meningitis caused by Neisseria meningitides is known as meningococcal meningitis, while meningitis caused by Streptococcus pneumoniae is known as Pneumococcal meningitis. People become infected when they are in close contact with the discharges from the nose or throat of a person who is infected. The most common types of bacteria that cause bacterial meningitis are:

Streptococcus pneumoniae, which is typically found in the respiratory tract, sinuses, and nasal cavity and can cause what’s called “pneumococcal meningitis”

Neisseria meningitidis, which is spread through saliva and other respiratory fluids and causes what’s called “meningococcal meningitis”

Haemophilus influenza, which can cause not only meningitis but infection of the blood, inflammation of the windpipe, cellulitis, and infectious arthritis

Listeria monocytogenes, which is a foodborne bacteria

BACTERIAL MENINGITIS IN NEWBORNS AND PREMATURE BABIES

A type of streptococci, called group B streptococci commonly inhabits the vagina and is a common cause of meningitis among premature babies and newborns during the first week of life. Escherichia coli, which inhabit the digestive tract, may also cause meningitis among newborns. Meningitis that occurs during epidemics can affect newborns – Listeria monocytogenes being the most common.

BACTERIAL MENINGITIS IN CHILDREN UNDER 5

Children under five years of age in countries that do not offer the vaccine are generally infected by Haemophilus influenzae type B.

BACTERIAL MENINGITIS IN OLDER CHILDREN

Older children generally have meningitis caused by Neisseria meningitides (meningococcus), and Streptococcus pneumoniae (serotypes 6, 9, 14, 18 and 23).

BACTERIAL MENINGITIS IN ADULTS

About 80% of all adult meningitis is caused by N. meningitidis and S. pneumoniae. People over 50 years of age have an increased risk of meningitis caused by L. monocytogenes.

BACTERIAL MENINGITIS AND PEOPLE WITH SKULL DAMAGE IMPLANTED DEVICES

People who received a recent trauma to the skull are at increased risk of bacteria in their nasal cavity entering the meningeal space. Patients with a cerebral shunt or related device also run a higher risk of infection with staphylococci and pseudomonas through those devices.

BACTERIAL MENINGITIS AND WEAK IMMUNE SYSTEMS

People with weak immune systems are also at higher risk of infection with staphylococci and pseudomonas.

BACTERIAL MENINGITIS AND EAR INFECTIONS AND PROCEDURES

Rarely, otitis media, mastoiditis, or some infection to the head or neck area may lead to meningitis. People who have received a cochlear implant run a higher risk of developing pneumococcal meningitis. A study published in Otolaryngology-Head and Neck Surgery found that children who are stricken with severe hearing loss are five times more likely to contract meningitis. In countries where tuberculous meningitis is common, there is a higher incidence of meningitis caused by Mycobacterium tuberculosis.

ANATOMICAL DEFECTS OR DISORDERS OF THE IMMUNE SYSTEM

Either congenital or acquired anatomical defects may be linked to recurrent bacterial meningitis. An anatomical defect might allow a way to penetrate into the nervous system from the external environment. The most common anatomical defect which leads to meningitis is skull fracture, especially when the fracture occurs at the base of the brain, or extends towards the sinuses and petrous pyramids. 59% of recurrent meningitis cases are due to anatomical defects, while 36% are due to weakened immune systems.

SIGNS AND SYMPTOMS

As meningitis and septicemia tend to show similar symptoms and incidences of both tend to rise and fall at the same time in geographical areas, this section refers to both meningitis and septicemia.

Meningitis is not always easy to recognize. In many cases meningitis may be progressing with no symptoms at all. In its early stages, symptoms might be similar to those of flu. However, people with meningitis and septicemia can become seriously ill within hours, so it is important to know the signs and symptoms. 

EARLY SYMPTOMS OF MENINGITIS BROADLY INCLUDE:

Vomiting

Nausea

Muscle pain

High temperature (fever)

Headache

Cold hands and feet

A rash that does not fade under pressure. This rash might start as a few small spots in any part of the body - it may spread rapidly and look like fresh bruises. This happens because blood has leaked into tissue under the skin. The rash or spots may initially fade, and then come back.

IN BABIES, YOU SHOULD LOOK OUT FOR THE FOLLOWING SIGNS AND SYMPTOMS:

A high-pitched, moaning cry

A bulging fontenelle

Being difficult to wake

Floppy and listless or stiff with jerky movements

Refusing feeds

Rapid/ unusual/ difficult breathing

Pale or blotchy skin

Red or purple spots that do not fade under pressure

IN OLDER CHILDREN, YOU SHOULD LOOK OUT FOR THE FOLLOWING SIGNS AND SYMPTOMS:

A stiff neck

Severe pains and aches in your back and joints

Sleepiness or confusion

A very bad headache

A dislike of bright lights

Very cold hands and feet

Shivering

Rapid breathing

Red or purple spots that do not fade under pressur

THE COMPLICATIONS THAT ARE TYPICALLY ASSOCIATED WITH MENINGITIS ARE:

Seizures

Hearing loss

Brain damage

Hydrocephalus

A subdural effusion, or a buildup of fluid between the brain and the skull

OUTBREAK

IN NIGERIA (APRIL 2017)

More than 2,524 people have so far been affected by the Cerebrospinal meningitis (CSM) outbreak, with 328 deaths recorded in ninety Local Government Councils of 16 states of the federation. The Federal Ministry of Health, which churned out these frightening statistics, also disclosed that so far, a total 131 samples have been confirmed in the Laboratory, out of which a majority is Neisseria Meningitides type C. Nigeria has a long history of  CSM epidemics. One of the worst occurred in 1996 when 109,580 cases and 11,717 deaths were recorded. In 2003, there were 4,130 cases and 401 deaths; 9,086 cases and 562 deaths in 2008, and 9,086 cases and 562 deaths recorded in 2009. The historical records and past experiences influenced health authorities in Africa (especially countries within the African Meningitis Belt), the World Health Organization and Development Partners to roll out a strategic intervention for the effective prevention of such epidemics. As at Friday, March 31, 2017, there were 2,524 infections with 328 deaths recorded in 90 Local Government Areas in 16 States of the Federation. 

The affected States include Zamfara, Katsina, Sokoto, Kebbi, Niger, Nassarawa , Jigawa, FCT, Gombe, Taraba and Yobe. Others are Kano, Osun, Cross Rivers, Lagos and Plateau. According to the Centers for Diseases Control and Prevention, CDC, bacterial meningitis is very serious and can be deadly. Death can occur in as little as a few hours, and even though most people recover from meningitis, however, permanent disabilities (such as brain damage, hearing loss, and learning disabilities) can result from the infection. A total of 146 positive cases confirmed by Pastorex and Culture; Neisseria meningitides serotype C being the most common serotype, accounting for 83% of cases. The most affected age group is 5-14 years of age. First report of suspected case began in week of 2016 in Zamfara; cumulative of  Epid weeks.

Risk of international border transmission; Zurmi LGA in Zamfara State, Gada LGA in Sokoto State and Jibia LGA in Katsina State share borders with Niger Republic. 500,000 doses of the AC-PS vaccine granted by the International Coordinating Group on Vaccine Provision (ICG) for reactive vaccination in Zamfara has arrived Nigeria. Reactive Vaccination has been re-scheduled for 5th – 9th April 2017 in Zamfara State, while Sokoto and Katsina’s International Coordinating Group on Vaccine Provision (ICG) requests are considered. 

IN NEW YORK, USA (OCTOBER 2007)

An 18-year old female student at Bentley College in Waltham, Greater Boston, Massachusetts, died in New York yesterday, Monday 8th October, from bacterial meningitis, according to a report in the Boston Globe. Erin Ortiz, a first year student, was visiting her family in New Hampton, New York when she fell ill and was admitted to Westchester Medical Center. The college authorities at Bentley are urging anyone who may have had close contact with Ortiz to seek medical attention and start taking antibiotics as a precaution. The infection is passed through contact with an infected person's saliva, such as during kissing, sharing a cup or sharing food. Bentley vice president, Kathleen York is said in an email to the college community that Erin was greatly loved and had a wide circle of friends. She said the loss affects everyone, and the way to honour Erin's memory was to reach out and take care of each other, said the report in the Boston Globe.

PREVENTION

HEALTHY LIFESTYLES

Maintaining a healthy lifestyle, especially if you’re at increased risk, is important. This includes things like:

Getting adequate amounts of rest

Not smoking

Avoiding contact with infected people

Avoiding overcrowding

Practicing of personal hygiene e.g. hand washing after visiting the toilet

AVOID CONTACT WITH INFECTED PEOPLE

Some forms of bacterial meningitis are contagious. The bacteria are spread through respiratory droplets and saliva, such as through kissing, coughing, and sneezing. You are at greater risk of contracting meningitis if you:

Are in close or prolonged contact with someone who has meningitis, such as in a daycare setting or shared household

Have direct contact with a sick patient's oral secretions

Live in an area with poor food and water hygiene – you can get some types of bacterial meningitis from contaminated food and water

If you’ve been in close contact with one or more people who have a bacterial meningococcal infection, your doctor can give you preventive antibiotics. This will decrease your chances of developing the disease.

GET VACCINATED 

Vaccinations can also protect against certain types of meningitis. Vaccines that can prevent meningitis include the following:

Haemophilus influenzae type B (Hib) vaccine

Pneumococcal conjugate vaccine

Meningococcal vaccine

Meningococcal vaccines protect against most types of meningitis, although they do not prevent all cases. There are two vaccines against Neisseria meningitis, a common infecting bacteria, meningococcal conjugate vaccine (MCV4), and meningococcal polysaccharide vaccine (MPSV4). MCV4 is the preferred vaccine for people ages 2-55. If your child did not get this vaccine at their 11 or 12 year old check-up, make an appointment for them to get it now.

VACCINATE YOUR CHILD AGAINST HAEMOPHILUS INFLUENZAE TYPE B (HIB)

Hib is a bacterial infection that can cause meningitis in children. The Hib vaccine is the best way to prevent Hib infection and is 95% effective. All children younger than 5 years old should get the Hib vaccine. Make sure your child gets all doses for the best protection, and if you miss a dose or get behind schedule get the next dose as soon as you can. Children should get a series of vaccines at 2 months, 4 months, 6 months, and 12-15 months of age.

GET TESTED FOR GROUP B STREPTOCOCCUS IF YOU’RE PREGNANT

Pregnant women can pass group B streptococcus bacteria to their infant during childbirth. Group B strep is another cause of meningitis in young children. If you’re pregnant, get tested for group B strep by your doctor. They can give you antibiotics during labor to reduce the risk of passing the bacteria to your baby. Get tested between 35-37 weeks of your pregnancy.

SEEK TREATMENT EARLY 

Early diagnosis and treatment of meningitis are very important to prevent life-threatening complications. As soon as you notice symptoms occurring, see your doctor immediately. Your doctor can diagnose meningitis by growing bacteria from a blood sample or fluid obtained with a spinal tap (or “lumbar puncture”). A spinal tap is performed by inserting a needle into an area in the lower back where fluid in the spinal canal is readily attainable – it’s a relatively quick procedure and isn’t too uncomfortable. Treatment will begin as soon as meningitis is diagnosed, or possibly even while you’re awaiting diagnosis.

RISK FACTORS FOR CEREBROSPINAL MENINGITIS

Certain groups of people are at higher risk of getting meningitis. It is especially recommended that these groups get vaccinated against the illness. Be aware if you are in one of the following high-risk groups: 

COMPROMISED IMMUNITY

People with an immune deficiency are more vulnerable to infections. This includes the infections that cause meningitis. Certain disorders and treatments can weaken your immune system.

HIV/AIDS

Autoimmune disorders (Anyone who has terminal complement component deficiency (an immune system disorder), or are otherwise immunocompromised).

Chemotherapy

Organ or bone marrow transplants 

Anyone who has a damaged spleen or whose spleen has been removed

 Cryptococcal meningitis, which is caused by a fungus, is the most common form of meningitis in people with HIV or AIDS.

COMMUNITY LIVING

Meningitis is easily spread when people live in close quarters. Being in small spaces increase the chance of exposure. Examples of these locations include:

Military recruits e.g. barracks

College students living in dormitories, and other groups living in close proximity

Microbiologists or other healthcare professionals exposed to meningococcal bacteria

Anyone traveling to countries which have an outbreak of meningococcal disease. If traveling overseas, check to see if the vaccine is recommended – you should receive the vaccine at least 1 week before departure.

Those who might have been exposed to meningitis during an outbreak

Young babies, under the age of 2

Boarding schools 

Day care centers

PREGNANCY

Pregnant women have an increased risk of listeriosis, which is an infection caused by the Listeria bacteria. Infection can spread to the unborn child.

AGE

All ages are at risk for meningitis. However, certain age groups have a higher risk. Children under the age of 5 are at increased risk of viral meningitis. Infants are at higher risk of bacterial meningitis.

WORKING WITH ANIMALS

Farm workers and others who work with animals have an increased risk of infection with Listeria.

INTERVENTION / SOLUTION

Meningitis treatment will generally depend on four main factors:

The age of the patient

The severity of the infection

What organism is causing it?

Are other medical conditions present?

Viral meningitis will resolve itself fairly quickly and does not usually need any medical treatment. If symptoms continue after two weeks the person should see his/her doctor. The treatment for severe meningitis, which is nearly always bacterial (but can be viral), may require hospitalization, and includes:

ANTIBIOTICS: Usually administered intravenously by injection, or through an IV.

CORTICOSTEROIDS: If the patient's meningitis is causing pressure in the brain, corticosteroids, such as dexamethasone, may be administered to adults and children.

ACETAMINOPHEN (PARACETAMOL): Effective in bringing the patient's temperature down. Other methods for reducing the patient's fever may include a cool sponge bath, cooling pads, plenty of fluids, and good room ventilation.

ANTI-CONVULSANTS: If the patient has seizures (fits), he/she will be given an anti-convulsant, such as phenobarbital or dilantin.

OXYGEN THERAPY: If the patient has breathing difficulties oxygen therapy may be given. This may involve a face mask, a nasal cannula, a hood, or a tent. In more severe cases a tube may be inserted into the trachea via the mouth.

FLUID CONTROL: Dehydration is common for patients with meningitis. If a meningitis patient is dehydrated he/she may develop serious problems. It is crucial that he/she is receiving adequate amounts of fluids. If the patient is vomiting, or cannot drink, liquids may be given through an IV.

BLOOD TESTS: Measuring the patient's blood sugar and sodium is important, as well as other vital body chemicals.

SEDATIVES: These are given if the patient is irritable or restless.If the meningitis is severe the patient may be placed in an ICU (intensive care unit).

REFERENCES 

Health Line: Meningitis

http://www.healthline.com/health/meningitis#overview1

Medical News Today: Meningitis: Causes, Symptoms and Treatments

http://www.medicalnewstoday.com/articles/9276.php?page=2

NetDoctor: Meningitis (cerebrospinal meningitis)

http://www.netdoctor.co.uk/conditions/pregnancy-and-family/a9083/meningitis-cerebrospinal-meningitis/

The Guardian Newspaper: Cerebrospinal Meningitis: 328 deaths in 16 states

https://guardian.ng/news/cerebrospinal-meningitis-328-deaths-in-16-states/

Vanguard Newspaper: Meningitis: What every Nigerian should know 

http://www.vanguardngr.com/2017/04/meningitis-every-nigerian-know/

WebMD: Understanding Meningitis

http://www.webmd.com/children/vaccines/understanding-meningitis-prevention

WikiHow.com: How to Treat Meningitis (Spinal Meningitis)

http://www.wikihow.com/Treat-Meningitis-%28Spinal-Meningitis%29

WikiHow.com: How to Recognize Spinal Meningitis Symptoms

http://www.wikihow.com/Recognize-Spinal-Meningitis-Symptoms

WikiHow.com: How to Diagnose Meningitis

http://www.wikihow.com/Diagnose-Meningitis