In November 2019, a new severe respiratory illness was reported in Wuhan City in the province of Hubei China. It was initially reported as a cluster of pneumonia cases whose etiology was not known but the WHO China Country office was not informed until on December 31, 2019.
On January 7, the Chinese authorities isolated a new type of coronavirus, which they named “2019 novel coronavirus”, it is a strain different from the coronaviruses that cause common flu in humans, and the National Health Commission of China associated this new strain with exposures in one seafood market in Wuhan city.
This forced a closure of the market and a total lockdown of the province of Hubei in attempt to contain the disease and prevent a spread beyond the province. However, in spite of this effort, the first exported case was reported in Thailand on 13th January 2020, followed by Japan and South Korea on the 15th of January and 20th of January 2020 respectively.
The WHO in February renamed the virus officially as ‘Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the respiratory disease it causes as ‘Coronavirus Disease-19 (COVID-19). Many countries across all continents began to report cases and the COVID-19 continued to spread with such rapid escalation that the WHO declared it a pandemic on March 11, 2020.
Today, there are almost a million and a half (1,436,198) confirmed cases and a little above eighty-five thousand deaths (85,522) in two hundred and twelve countries worldwide (WHO, April 9, 2020). Ghana is not spared either, since recording her first two confirmed cases on the 12th of March 2020, the country has mounted stringent surveillance measures for case detection and continues to record a rise in the number of confirmed cases with three hundred and thirteen (636) cases of COVID19 with eight (8) deaths as of April 14, 2020.
As governments the world over, and Ghana in particular channel their efforts and resources towards fighting this COVID-19 pandemic, there is an old and seemingly well-known disease called Cerebrospinal meningitis, otherwise known as CSM or Meningococcal meningitis which now lacks the needed attention, claiming precious lives in Ghana, particularly lives of our brothers and sister and their children in the northern half of the country.
Whilst COVID-19 is caused by a virus, CSM or meningitis can be caused by different pathogens including viruses, bacteria and fungi but bacterial caused meningitis is responsible for the highest global burden and mortality. Both COVID-19 and CSM are transmitted by droplet infection, meaning when an infected person sheds the pathogen in saliva or throat and nasal secretions through a cough or a sneeze respectively, the aerosolized pathogen can be spread airborne or from touching a surface with the droplet and infecting oneself through touching the eyes, mouth or nostrils.
COVID-19 symptoms are mostly respiratory in nature such as sore throat, dry cough, unexplained loss of taste (ageusia) and smell (anosmia) and shortness of breath. Fever and muscle aches are two other symptoms. Patients may be asymptomatic, with ninety-five (95%) percent presenting with mild disease and some five (5%) percent requiring intensive care. Fatality rate is only about some 5.9%. Meningitis on the other hand has a 50 percent mortality rate if not treated and may leave serious permanent brain damage (in 10% to 20% of cases) if treatment is delayed.
Meningitis refers to an inflammation of the meninges, the protective covering of the brain and the spinal cord. In the meningitis caused by bacteria, the bacterial pathogens infect only humans; there is no known animal reservoir. Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type B represent the triad causing over 80% of bacterial meningitis burden worldwide. Transmission is from person-to-person through droplets of respiratory or throat secretions from carriers.
Smoking, close and prolonged contact—such as kissing, sneezing or coughing on someone, or living in close quarters with a carrier– facilitates the spread of the disease. The bacteria can be carried in the throat and when it overwhelms the body’s defenses, it is allowed to spread through the bloodstream to the brain, inflame the meninges and cause neurological symptoms. It is believed that 1% to 10% of the population carries N. meningitidis in their throat at any given time. However, the carriage rate may be higher (10% to 25%) in epidemic situations (WHO Key facts, Feb. 2018).
There are no reliable estimates of global meningococcal disease burden due to inadequate surveillance in several parts of the world, however, the largest burden of meningococcal disease occurs in an area of sub-Saharan Africa known as the meningitis belt, which stretches from Senegal in the west to Ethiopia in the east (comprising 26 countries).
The mean incubation period is four days but can range between two and ten days. The most common symptoms are severe headache with sensitivity to light (photophobia), a painful stiff neck, high grade fever, vomiting, confusion, convulsion and coma. Infants present with a bulging fontanelle and a ragdoll appearance.
A less common but even more severe (often fatal) form of meningococcal disease is meningococcal septicaemia, which is characterized by a haemorrhagic rash and rapid circulatory collapse. Even when the disease is diagnosed early and adequate treatment is started, 8% to 15% of patients die, often within 24 to 48 hours after the onset of symptoms.
If untreated, meningococcal meningitis is fatal in 50% of cases and may result in brain damage with recurring seizures, hearing loss or disability in 10% to 20% of survivors (WHO Key facts, Feb. 2018).
The diagnosis of meningococcal meningitis is made by clinical examination followed by a lumbar puncture and spinal fluid laboratory study. The bacteria can sometimes be seen in microscopic examinations of the spinal fluid. The diagnosis is supported or confirmed by growing the bacteria from specimens of spinal fluid or blood, by latex agglutination tests or by polymerase chain reaction (PCR) where the nuclear material of the pathogen is detected.
Because of its potentially fatal nature, meningococcal meningitis requires early reporting of symptoms, early case detection and early initiation of treatment.
The appropriate antibiotics must be initiated as soon as possible, ideally after the lumbar puncture has been carried out especially if the facility can support it. However if confirmation of diagnosis by a lumbar puncture and CSF microscopy is not possible immediately, treatment should not be delayed.
Watch out for Part 2
Source: Dr. Frederick Mawuli Agbemafoh (Bsc, Mbchb)
Deputy Medical Manager, Cocoa Clinic, Sefwi-Debiso
Western North Region
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