This week, cerebrospinal meningitis is on the news. This disease, which is majorly prevalent during the dry season has been reported to be ravaging five states in the North-West region of Nigeria including- Zamfara, Sokoto, Kebbi, Katsina and Niger States.

1. MENINGITIS#STAYSAFE: ALERT POINTS FOR MENINGOCOCCAL MENINGITIS
epidalertInformative Initiative

2. INTRODUCTION
Cerebrospinal Meningitis (CSM) is a
serious infection of
the Meninges, a thin layer of the
connective tissue that
covers the brain and the spinal
cord.
Meningococcal meningitis is
a bacterial form of
meningitis.
It is of great public health
importance because
It has a high morbidity and
fatality rate
It is epidemic prone
It is treatable

3. CAUSES OF BACTERIAL MENINGITIS
pathogenic agents
enter through the blood
Cerebral Cortex (Brain)
(inflamed)
Pia mater
(inflamed)
Arachnoid
(inflamed)
Dura mater
Skull
Skin
ree predominant germs are responsible for > 70% of bacterial meningitis
cases. ey are Neisseria meningitides, Haemophilus influenza b
and Streptococcus pneumonia. A small percentage of cases
are caused by others, including, Staph. aureus, Pseudomonas
spp, Listeria, Strep. pyogenes and Mycobacterium tuberculosis (TB).
e extended meningitis belt of sub-Saharan Africa, stretching from
Senegal in the west to Ethiopia in the east (26 countries including
Benin, Burkina Faso, Chad, Niger, Nigeria and Mali make up the
Meningitis belt), has the highest rates of the disease. is areas is
home to about 350 million people.

4. Epidemic meningitis is often caused by, Neisseria meningitides Sero-group
A, B and C (meningococcus)2,3. Other sero-groups X, Y, W13 rarely cause
epidemics.
In Nigeria, cases can occur all through the year and increase during the dry
season. Outbreaks occur every year between December and May. e dry
season, withstrongdustywindsandcoldnightsmakepeoplemoreproneto
respiratory infections and facilitates the spread of bacteria. An epidemic
threshold is used to differentiate
epidemic emergence from simple
seasonal rise in incidence.
Epidemic meningitis diseases
caused by the meningococcus
bacteriaiscommoninNigeria.
Humans are the only known
reservoir for meningitis bacteria.
It affects humans of all age
groups, irrespectiveof gender, but
commoner in extremes of age (0 -
5yrs,>65yrs).
CAUSES OF BACTERIAL MENINGITIS CONTD.

5. MODE OF TRANSMISSION OF
BACTERIAL MENINGITIS
Direct contact including droplets from nose and throat of infected person.
Transmission is facilitated by close and prolonged contact (such as sneezing
and coughing), overcrowding & certain climatic conditions like dry season.
In-between epidemics, meningococcal bacteria survive in the nasopharynx
of asymptomatic carriers. Malnutrition has been identified as a factor.

6. COMMON SYMPTOMS
Fever
Headache
Vomiting
Neck stiffness
Altered level of consciousness
Photophobia

7. LABORATORY DIAGNOSIS
Diagnosis is by direct testing of patients’ cerebrospinal fluid (CSF)
collected through lumbar puncture. A lumbar puncture is a skilled
procedure, involves collecting cerebrospinal fluid, which bathes the
meninges, from the lower back of a suspected case, for diagnosis and
treatment. A blood sample is usually taken concurrently for analysis.
e stages of diagnosis are as follows:
1. Macroscopic examination: - Normal CSF is a clear fluid, turbidity is
indicative of severe meningitis.
2 .Cytological examinations: - Meningitis often presents with elevated CSF
white blood cell count, >1000cells/mm3
3. Examination of Gram stained smear: - Gram stain can successfully
identify causative organism. Gram negative diplococci is N. meningitides,
Gram negative rods is H. influenza and Gram positive, capsulated
diplococci is S. pneumonia.
4. Culture and antimicrobial susceptibility testing: - Gold standard for
identification of meningitis bacteria. Positive growth is always followed
with susceptibility testing
5. Latex agglutination test for antigen detection: - Rapid, sensitive and
expensive commercially available antigen detection kits a very useful
under field conditions. ey are helpful in re-testing initial gram stain and
culture negative samples including those pre-treated with antibiotics
6. Other diagnostic methods: - include blood cultures, flow cytometry and
Polymerase chain reaction (PCR)

8. Recommended for contacts of persons with meningococcal meningitis
(eg, in households, daycare centers, military barracks or boarding schools,
and medical personnel performing mouth-to-mouth resuscitation).
Rifampin (600 mg PO every 12 hours for 2 days) can rapidly eradicate the
carrier stage, and the prophylaxis persists for as long as 10 weeks after
treatment.
Alternative agents for adults include ceftriaxone (250 mg IM in a single
dose); this agent is also the safest choice in pregnant patients. Ceftriaxone
has been shown to eradicate the carrier state for 14 days. Ciprofloxacin
(500-750 mg in a single dose) is also effective.
THE ROLE OF CHEMOPROPHYLAXIS

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