Hocus-pocus Meningococcus
Life is beautiful for young people in their primes, with everything to live for. Then, “hocus-pocus,” sudden headaches, fever, malaise, confusion, eye discomfort to light, and a literal pain in the neck, and all that changes. Hearing loss, neurologic deficits, and the ultimate “disappearing act” leave no doubt that this was black magic.
From schoolyards to college campuses, masters of deception levitate in the air, infiltrate large groups of people, and finally decimate central nervous systems with sleight of hand. Bacteria, mycobacteria, fungi, spirochetes, protozoa, helminths, and viruses are their names, but on their marquees is emblazoned a simple, “MENINGITIS.” As beguiling as Houdini, they often seek instant gratification, presenting acutely to a virtually limitless audience within hours to 1-2 days after the appearance of nonspecific cold or flu symptoms. On a whim, they may prolong their tours, performing less frequently, with hiatuses of weeks to months of general symptoms. Let there be no mistake, however, what they are selling is not pure entertainment, but medical emergency.
Their youngest fans are 3 months old and lie in cribs. Their oldest lie in nursing homes, and no one inbetween is immune to their charms. With enigma as a tool of their trade, they often go undiagnosed until the final act. One-third of meningitis cases, in fact, go undetected despite careful laboratory evaluation.
In order to banish our infectious friends in a “puff of smoke,” we must first understand what we are up against. It is common knowledge that meningitis is an infection and inflammation of the membranes, which are called meninges, and cerebrospinal fluid (CSF) surrounding the brain and spinal cord. With the advent of current vaccines, there has been a shift in preferred “live targets,” from children younger than 5 years old to the 15-24-year-old age group and older adults. Audiences, too, have indeed become “captive,” with 700 Americans dying of meningitis each year.
Viral meningitis, also called aseptic meningitis, usually results from the spread of enteroviruses through direct contact with respiratory secretions (e.g., saliva, sputum, or nasal mucus) of an infected person. It causes signs and symptoms for 10 days, followed by resolution on its own. Supportive intervention is all that is needed, and the cause may never actually be found. Have you ever asked a magician where the rabbit he has pulled out of his hat comes from?
Bacterial meningitis, on the other hand, is the stuff of sorcerers, Wiccans, and wizards. It is much more serious than viral meningitis, and the curtain goes up when infection in another area of the body threads blood vessels and a path to the meninges. Signs and symptoms are varied, but, with over 50,000 hospitalizations in the U.S. each year due to some form of meningitis and its nefarious bag of tricks, it pays to be vigilant. In addition to the common manifestations of the malady listed above, others include neck stiffness, vomiting, seizures, lethargy, delirium, and focal neurologic signs, the latter particularly alarming and requiring a computed tomography (CT) scan to rule out cerebral edema.
Timely diagnosis relies on the thrust of a magic wand, commonly known as a lumbar puncture needle, between lumbar vertebrae L4 and L5 for collection of cerebrospinal fluid (CSF). Analysis of the opening pressure, color, culture, number of red and white blood cells, glucose, and proteins of that ethereal nectar is confirmatory to both the diagnosis of the disease itself and its etiologic agent.
That leaves only the esoteric pièce de résistance to put an end to the harbingers of meningitis before they put an end to us. If meningitis is not eliminated immediately, presto chango, permanent neurologic sequelae, hearing loss among others, will inevitably result. Antibiotic therapy, for a minimum of 7 days and a maximum 3-4 weeks, depending on the bacterial agent involved, is the name of the game. With a clear and proactive focus, there is no need for hocus-pocus.
From schoolyards to college campuses, masters of deception levitate in the air, infiltrate large groups of people, and finally decimate central nervous systems with sleight of hand. Bacteria, mycobacteria, fungi, spirochetes, protozoa, helminths, and viruses are their names, but on their marquees is emblazoned a simple, “MENINGITIS.” As beguiling as Houdini, they often seek instant gratification, presenting acutely to a virtually limitless audience within hours to 1-2 days after the appearance of nonspecific cold or flu symptoms. On a whim, they may prolong their tours, performing less frequently, with hiatuses of weeks to months of general symptoms. Let there be no mistake, however, what they are selling is not pure entertainment, but medical emergency.
Their youngest fans are 3 months old and lie in cribs. Their oldest lie in nursing homes, and no one inbetween is immune to their charms. With enigma as a tool of their trade, they often go undiagnosed until the final act. One-third of meningitis cases, in fact, go undetected despite careful laboratory evaluation.
In order to banish our infectious friends in a “puff of smoke,” we must first understand what we are up against. It is common knowledge that meningitis is an infection and inflammation of the membranes, which are called meninges, and cerebrospinal fluid (CSF) surrounding the brain and spinal cord. With the advent of current vaccines, there has been a shift in preferred “live targets,” from children younger than 5 years old to the 15-24-year-old age group and older adults. Audiences, too, have indeed become “captive,” with 700 Americans dying of meningitis each year.
Viral meningitis, also called aseptic meningitis, usually results from the spread of enteroviruses through direct contact with respiratory secretions (e.g., saliva, sputum, or nasal mucus) of an infected person. It causes signs and symptoms for 10 days, followed by resolution on its own. Supportive intervention is all that is needed, and the cause may never actually be found. Have you ever asked a magician where the rabbit he has pulled out of his hat comes from?
Bacterial meningitis, on the other hand, is the stuff of sorcerers, Wiccans, and wizards. It is much more serious than viral meningitis, and the curtain goes up when infection in another area of the body threads blood vessels and a path to the meninges. Signs and symptoms are varied, but, with over 50,000 hospitalizations in the U.S. each year due to some form of meningitis and its nefarious bag of tricks, it pays to be vigilant. In addition to the common manifestations of the malady listed above, others include neck stiffness, vomiting, seizures, lethargy, delirium, and focal neurologic signs, the latter particularly alarming and requiring a computed tomography (CT) scan to rule out cerebral edema.
Timely diagnosis relies on the thrust of a magic wand, commonly known as a lumbar puncture needle, between lumbar vertebrae L4 and L5 for collection of cerebrospinal fluid (CSF). Analysis of the opening pressure, color, culture, number of red and white blood cells, glucose, and proteins of that ethereal nectar is confirmatory to both the diagnosis of the disease itself and its etiologic agent.
That leaves only the esoteric pièce de résistance to put an end to the harbingers of meningitis before they put an end to us. If meningitis is not eliminated immediately, presto chango, permanent neurologic sequelae, hearing loss among others, will inevitably result. Antibiotic therapy, for a minimum of 7 days and a maximum 3-4 weeks, depending on the bacterial agent involved, is the name of the game. With a clear and proactive focus, there is no need for hocus-pocus.
Copyright 2005, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
7/09/2006 11:56:00 AM
2 Comments:
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