Meningococcemia: Sudden Death

JACLYN thought her 5-year-old daughter, Gina, just had flu when she accompanied her to sleep. She was wrong. Gina was much sicker the following day. She went from being fussy to unnaturally quiet, unresponsive and limp. While Gina had fever when she was going to sleep, now her hands and feet were cool, pale and clammy.

When Jaclyn changed her daughter’s clothes, she observed that Gina had purple spots on her tummy and legs. The mother was very much worried, so she immediately called her doctor. “Bring your daughter here immediately,” the doctor said.

While driving very fast, Jaclyn held her daughter’s cold hands and saw that some of her fingertips were turning blue. Before they reached the hospital, Gina succumbed.

Gina died of meningococcemia, one of very few diseases that can kill a healthy child within hours, according to health experts. In medical parlance, it is called Meningococcal meningitis, a bacterial form of meningitis. 

“A variety of organisms, including different bacteria, fungi or viruses, can cause meningitis,” the Geneva-based World Health Organization (WHO) reports. Meningococcemia can cause severe brain damage and is fatal in 50 percent of cases if untreated.

This blood infection is caused by the gram-negative bacteria Neisseria meningitidis (N. meningitidis), which is normally found in common throat disorders. The United Nations health agency says there are 12 types of N. meningitidis, six of which can cause epidemics. Outside the human body, these fragile bacteria cannot survive in natural conditions.

Meningococcemia can cause is an acute and potentially life-threatening infection of the bloodstream. According to Dr. Lulu Bravo, professor emeritus at the University of the Philippines-Manila’s College of Medicine, meningococcemia can be so severe as to cause death within 24 hours after initial onset of fever and purpuric rashes (purplish spots caused by bleeding tiny blood vessels beneath the skin’s surface).

It has been established that meningococcal disease is transmitted only through droplets of respiratory or throat secretions from carriers (such as kissing, sneezing or coughing on someone or living in close quarters).

Getting protected via vaccine is crucial because meningococcal disease generally infects infants, children and adolescents in the 15 to 19 age group. It is important to get immunized considering that there is a vaccine that protects against four groups of N. meningitidis: group A, group C, group Y and group W-135.

According to health experts, when the bacteria infect the meninges—the membranes around the brain and spinal cord— it causes meningitis. Widely feared by parents, meningitis is easily recognized; most cases are diagnosed quickly and treated effectively with antibiotics. But when these same bacteria invade a child’s bloodstream, early symptoms are hard to distinguish from other childhood infections.

“Meningococcemia is a dangerous disease requiring early and aggressive treatment to prevent a potentially lethal outcome,” Dr. Warren Howe writes in an article for The Physician and Sports Medicine. “It often occurs in relatively closed groups, including sports camps and athletic teams.”

Dr. Howe cites the case of a 10-year-old boy, who was attending a summer sports camp. At 5 a.m., the little boy woke the trainer and told him that he was feeling hot and having nausea and abdominal pain. The trainer alertly notified the camp physician, who saw the little boy shortly thereafter and noted an ill-appearing patient with a very high temperature. He thought the boy had meningitis but there were no symptoms of such.

By the time the patient was transferred to the hospital, he had developed a number of small purplish spots on his limbs and trunk. The doctors immediately instituted antibiotic treatment and the boy made an excellent recovery. 

Almost simultaneously with the patient’s hospital admission, a friend of the patient—with whom the patient had attended a swim meet two days before departing to camp—was admitted to the same hospital with similar symptoms. This second 9-year-old boy was also successfully treated for meningococcemia.

The disease-causing bacteria “only infects humans; there is no animal reservoir,” the WHO says.  It spares no one—including adults. But most of those who succumbed are children. Of the 77 meningococcemia cases reported in 2010, for instance, 17 deaths were reported, with the highest incidence coming from those below four years old.

N. meningitides are transmitted from person-to-person by respiratory droplets. “At first, the bacteria colonize the upper airway and the victim doesn’t notice it at all,” a medical science book explains. “From there, it may penetrate into the bloodstream to the central nervous system and cause meningitis or develop into a full-blown bloodstream infection (meningococcemia). Fortunately in most colonized people, this does not happen and the result of this colonization is long-lasting immunity against the particular strain.

“After colonization is established, symptoms can develop within one day to one to two weeks. After a short period of time (one hour up to one to two days), when the patient complains of fever and muscle aches, more severe symptoms can develop. Unfortunately during this early stage, a doctor cannot tell this illness from any other illness, such as a viral infection like flu,” the book continues. 

Unless the case is occurring in a person known to have been exposed to or in the midst of an epidemic of meningococcal disease, there may be no specific symptoms or signs found that can help the doctor diagnose the problem.

“After this initial period, the patient will often complain of continued fever, shaking chills, overwhelming weakness and even a feeling of impending doom,” the book goes on to explain. “The organism is multiplying in the bloodstream, unchecked by the immune system. The severity of the illness and its dire complications are caused by the damage the organism does to the small blood vessel walls. This damage is called a vasculitis, an inflammation of a blood vessel. Damage to the small vessels causes them to become leaky. The first signs of the infection’s severity are small bleeding spots seen on the skin. 

“Within hours, the blood-vessel damage increases and large bleeding areas on the skin are seen. The same changes are taking place in the affected person’s internal organs. The blood pressure is often low and there may be signs of bleeding from other organs (like coughing up blood, nose bleeds, blood in the urine). The organism not only damages the blood vessels by causing them to leak, but also causes clotting inside the vessels. If this clotting occurs in the larger arteries, it results in major tissue damage. Essentially, large areas of skin, muscle and internal organs die from lack of blood and oxygen. Even if the disease is quickly diagnosed and treated, the patient has a high risk of dying.”

The UN health agency says that “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 disease is not at all incurable but could be treated when detected early.  The WHO described meningococcemia as a “medical emergency.”  “Admission to a hospital or a health center is necessary,” the WHO says. 

In addition to intravenous antibiotics, patients in intensive care will likely require intravenous fluids and sometimes medications to help maintain and support an adequate blood pressure. “Some patients may require ventilator support if they develop respiratory distress,” the medicinenet.com says.

Family members and those closely exposed to an infected individual are advised to take antibiotics, too. In like manner, children suspected to have contact with those who were infected are also recommended to take antibiotics. “People who have been exposed to N. meningitidis should be monitored for 10 to 14 days to make sure they do not develop symptoms,” medicinenet.com advises.

For caretakers and health workers, frequent hand washing is recommended to minimize the transfer of infected secretions to the mouth or nose.

According to doctors, meningococcemia can be prevented and controlled by maintaining cleanliness and by avoiding crowded places and close contact with those suspected to have acquired the disease. 

Turning Points 2018
Suntrust banner2