10 things to know about meningitis in Kenya

Meningitis can be a life threatening illness if not quickly diagnosed and managed appropriately. The bigger part of this write up will cover bacterial meningitis since it is the one that is contagious and causes outbreaks. Other causes will be mentioned in brief.

  1. What is meningitis? – Meningitis means infection of the covering of the brain. As meningitis4seen in this diagram of the head, we move from the skin to the bone, to the meninges (covering the brain) and then finally to the brain itself.
  2. What causes Meningitis? – Meningitis can be caused by very many things. These include;
    1. Bacteria – The commonest bacteria that causes meningitis is of the Neisseria group. This is the bacteria that causes the contagious form of meningitis and is responsible for outbreaks. Other common bacteria include Streptococcal pneumoniae, Hemophilus influenza and other Gram-negative bacilli.
    2. TB (Tuberculosis) – TB is technically a bacteria but it deserves a category of its own because in our country, TB is pretty common. One can get the common lung TB which then spreads through the blood to multiple sites that can include the meninges.
    3. Viruses – commonly encountered viruses can give rise to meningitis. These include Varicella that causes chicken pox, Herpes, Influenza and HIV.
    4. Fungus – More rarely, funguses can cause meningitis especially among immunocompromised people and commonly involves the Cryptococcal type.
    5. Parasites – Some parasites can gain access to the meninges causing meningitis and include malaria, amoeba, toxoplasma and others.
    6. Non-infective causes – Meningitis can also be due to other causes and these include cancers, drugs, Systemic Lupus Erythematosus (SLE), vasculitis and other conditions.
  3. How can one get bacterial meningitis?
    1. Inhale it – Bacterial meningitis organisms are accessed through inhalation of the bacteria from the secretions of an infected individual. These bacteria access the nose and pharynx and then access the blood. This may proceed to rapidly multiplying infective organisms in blood which is known as septicemia. These organisms then gain access to any organ which may include the brain covering to cause meningitis.
    2. Direct injury to the head – This is due to penetrating injuries to the head, face, eye, nose or ears from Road Traffic Accidents, fights or accidents. A recent case I came across was of a high school student who fell off a bed and hit his nose on a hard desk. The boy developed a nose bleed that stopped after a short while. Days later, he developed severe headache and fever and was subsequently discovered to have developed meningitis.
    3. Progression of disease from organs that communicate with the brain – Poorly managed infections of organs communicating with the brain can also lead to infection of the meninges through direct extension of the disease either through bone or following a nerve. Example is that of people who have runny, blocked noses go on to develop sinusitis and then progress to meningitis. Others have poorly managed eye infections that lead to orbital cellulitis and then to meningitis or middle ear infections (otitis media) leading to meningitis.
    4. Septicemia – This means that any infection from a different part of the body (e.g. lung, skin, ear, bone e.t.c.) spreads to the blood and then finds its way to the meninges.
  4. Symptoms of meningitis – Commonest triad of symptoms of meningitis include meningitis3fever, severe headache and neck stiffness. They are all usually present in only about 70% of patients.Other common symptoms include photophobia (fear of bright light), phonophobia (fear of loud noises), drowsiness or loss of consciousness
  5. Risk factors for meningitis.
    1. Poorly ventilated, crowded, living areas
    2. Very young and very old by virtue of their age.
    3. Immunosuppression – HIV, cancer, drugs, alcoholics, pregnancy
    4. Direct trauma to head – can be major RTA or even a small injury that causes an open communication path to the brain e.g. fracture nasal bones or middle ear or penetrating injury to the eye.
    5. Poorly managed infections of the eye, nose and ears.
    6. Septicemia secondary to infection from any other site in the body.
  6. Treatment of meningitis;
    1. Bacterial               – Antibiotics given intravenously is the mainstay of treatment.
    2. T.B                          – Anti TB drugs
    3. Viral                       – Usually self limiting but some anti-virals can be given for specific viruses.
    4. Parasitic               – Anti-parasitic medications
    5. Fungal                   – Antifungal medications.
  7. Complications of meningitis
    1. Brain damage – Infection and inflammation of the meninges causes fibrous tissue to form which then compresses the brain and this can lead to brain damage. The damage can be localized where a person recovers but a part of their brain is damaged like speech or vision.
    2. Encephalitis – A big term to mean that the infection has spread from the covering of the brain into the brain itself.
    3. Septicemia – As stated earlier, once infected material has found its way into the blood, it can be lodged at any organ causing organ damage. This is usually to the kidneys, heart, bones and joints.
    4. Death – Usually due to a combination of some of the above.
  8. Is there a vaccine to prevent bacterial meningitis? – There are various vaccines for the different causes of meningitis.
    1. Meningococcal Vaccine – This is not given routinely as any part of our immunization programs. First and foremost, it does not cover all types of the Neisseria bacteria that cause meningitis. This means that one can still get meningitis from the same bacteria they were vaccinated against but a specific subtype. Secondly, the effectivity of the vaccine is only about three years. This would suggest that one gets vaccinated every three years but the irony is that studies have shown that booster vaccines actually lower your immunity not increase it.
    2. Streptococcal pneumonia Vaccine – Newly introduced in Kenya as part ofpentavalent our KEPI program (Kenya Expanded Program on Immunization).
    3. Hemophilus influenza Vaccine – Given in children (pentavalent) as part of our KEPI program (Kenya Expanded Program on Immunization).
  9. What if there is an outbreak of meningitis? What happens?
    1. High risk people get vaccinated – This means people living in the vicinity of the person affected as well as medical personnel who will be involved in the management of the outbreak.
    2. Affected people are managed in isolation. In addition there is Isolation and monitoring of people who have been in direct contact with affected persons.
    3. Prophylaxis treatment can also be given to people who have been exposed. This can only be effective if the cause of meningitis has been determined with certainty.
  10. How common is meningitis in Kenya? – Unfortunately, there are no easily available studies to show the epidemiology of meningitis in Kenya. Single cases of meningitis are common in Kenya especially in immunocompromised individuals, in children and the elderly. This is usually due to any of the organisms mentioned above. However, outbreaks are rare in this country and only a small part of the country is considered to be in the Meningitis belt.meningitis belt
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