Meningococcemia is one of the few infections that can leave patients with significant morbidity and mortality in less than 24 hours after presentation. Despite major medical advances, it continues to cause devastating effects on children and young adults.
According to the World Health Organization (WHO), this disease is caused by the bacteria Neisseria meningitidis which are very fragile and cannot survive in natural conditions outside the human body, though this has possibly been more assumed than demonstrated. Humans are the only natural host for meningococci.
Meningococcal infections are endemic in Asian countries. However, most of its cases occur in an irregular manner and not in large incidents. In the Philippines, 32 out of 98 people died due to meningococcal disease from October 2004 to January 2005. By end of December 2010, the Philippines reported 77 cases of meningococcal disease with 17 deaths, with the highest incidence coming from those below four years old. There have been 1,458 reported cases of bacterial meningitis in the Philippines, with 130 deaths.
Invasive meningococcal disease (IMD), a life-threatening condition, is highly infectious and progresses rapidly, resulting in death within hours if not immediately recognized and treated, says Dr. Delta Aguilar, head at Section of Infectious Disease in Southern Philippines Medical Center.
The disease can be spread through common everyday activities such as crowding, living in close quarters like dormitories or summer camps, and kissing. Transmission of the bacteria occurs through airborne respiratory droplets expelled by infected people or through healthy asymptomatic carriers. Its contamination is seasonal occurring most of the time in colder months.
A person testing positive for this disease must incubate the bacteria within 2 to 10 days. Once infected, symptoms are similar to those of more common viral illnesses and may be difficult to recognize, especially in the early stages because the signs are nonspecific in the first six hours. “Initial symptoms usually present with fever, vomiting, headache, lethargy, and abdominal pain. “This can quickly evolve into bleeding rash (petechiae or purpura), altered mental status, meningeal irritation (meningismus) and rapid hemodynamic collapse,” Aguilar explains.
IMD can lead to meningococcal meningitis (swelling of the lining of the brain or spinal cord), meningococcemia (septicemia or blood infection), or pneumonia. Aguilar adds that meningitis may cause devastating consequences such as loss of hearing, blindness, mental retardation, brain injury, and paralysis, if not death. In the advent of septicemia, the bacteria enter the bloodstream and multiply uncontrollably, damaging the walls of the blood vessels and causing the appearance of hemorrhagic rash. The likelihood of dying is high at 30 percent especially in cases that are not treated immediately.
Antibiotics kill meningococcal bacteria and if taken early, it would help improve one's condition and increase chances of survival. “Restoring adequate oxygen and substrate delivery to tissues may be difficult to attain once the infection spreads. Although N. meningiditis is easily eradicated with antibiotics, the effects of the pathophysiology in progress can be irreversible,” says Aguilar. Meningococcemia is generally sensitive to penicillin G, cefotaxime, and ceftriaxone.
Some patients get worse initially after antibiotic administration due to endotoxin release. Despite antibiotic treatment, 10 to 15 in 100 people infected with meningococcal disease will die. About 11 to 19 in 100 survivors will have long-term disabilities, such as loss of limbs, deafness, nervous system problems, or brain damage.
As part of the campaign against meningococcemia, the Food and Drug Administration (FDA) recently approved the registration of a conjugate quadrivalent meningococcal vaccine which paves the way for the vaccine to be used, for the first time, in Asia Pacific.
“The campaign encourages individuals, families, and communities to learn the signs and symptoms of meningitis, the need to urgently treat the disease, and the fact that prevention is available through vaccination against some forms of meningitis,” Aguilar advises.
The Philippines is currently the only country outside of North America that has the vaccine that could protect against meningococcemia. For details on child and adult meningococcal vaccine administration and dosage, check this link for reference.