Nervous System Infections: Life in

the Meningitis Belt

Joseph Joo, Shannon Sturgeon,
Paul Davis, and Katie Montgomery

Case and Background

Meningitis outbreak reportedly moved through

the area where Saihun and her family lived.
They lived within the Khasi tribe of the East Khasi
Hills of Meghalaya.
Northeast region of India near the border between India
and Bangladesh
Subtropical rain forest usually wet and abundant with rain

On a day of celebration, it was hot and humid but

did not rain.

Case and Background

Reported meningitis outbreak moved along the

region where they were located from Bangladesh.
2,500 grew ill
230 deaths in the past
month
most cases occurred among
the 140,000 people in the
poor tribal-dominated areas
of Meghalaya.
incidence rate of
2,500/140,000

Case and Background

Saihuns father showed initial symptoms like

fever and headache the night of the celebration.
Next morning, he had an intense headache and a
stiff neck, was vomiting, and developed
photophobia. He also had an irregular rash on his
trunk and legs.
Saihuns family later was able to obtain necessary
antibiotics from a local clinic supplied by the
National Institute of Communicable Disease.

Symptoms of Meningitis
The symptoms may be confused with
that of the flu.
They may develop over several hours or
over a day or two.

Sudden high fever

Severe headache
Stiff neck

Symptoms of Meningitis

Vomiting or nausea with headache

Confusion or difficulty concentrating
Seizures
Sleepiness or difficulty waking up
Photophobia
Lack of interest in drinking and eating
Skin rash in some cases like that of
meningococcal meningitis

Transmission

Bacterial Meningitis
Contagious, far less common than the flu or common cold viruses
Exchange occurs between exchange of bodily fluids
Streptococcus pneumoniae and Neisseria meningitidis most common

Fungal Meningitis
Noncontagious, preexisting fungus enters bloodstream and infects CNS

Infection

Bacterial or fungal infection must become septic (enter

bloodstream)
Colonize nasopharynx -> enter bloodstream -> exit bloodstream in the brain
-> reach subarachnoid space

Subarachnoid space filled with cerebrospinal fluid (CSF)

Ideal for bacterial growth

Very few phagocytes

Nutrients

Subarachnoid space continuous with brain and spinal cord

Spreads to entire CNS via CSF -> inflammation of meninges -> Meningitis

Potential Side Effects

Systemic rash
Likely the same bacteria/fungus that caused the
meningitis infection.
Pathogen must become septic to reach brain/meninges
Infection just as likely to reach other body regions

Happened to spread to the torso/legs in Saihuns father

Clinical Tests

Often, a person is diagnosed by culturing cerebrospinal fluid obtained from a spinal tap -> this is
the most important diagnostic tool
Multiple vials may be obtained to ensure the validity of the results, i.e. only one positive vial is
contamination whereas multiple positive vials signifies infection
Low glucose levels, increased white blood cell count and increased protein levels are all signs
of an infection
X-rays and CT scans of the head, chest or sinus may also be obtained to check for swelling or
inflammation in other areas associated with meningitis

Obtaining CSF

Causative Organism Characteristics

Meningitis is usually caused by a virus but can also result from bacterial or fungal infection
Viral meningitis is usually caused by non-polio enteroviruses, but cases are often mild and clear
up on their own without clinical intervention
Bacterial meningitis is the most dangerous form and can be life-threatening
The most common strains that cause bacterial meningitis
o Streptococcus pneumoniae (pneumococcus)
o Neisseria meningitidis (meningococcus) -> this is the pathogen most associated with
outbreaks in the meningitis belt
o Haemophilus influenzae
Fungal meningitis is uncommon and causes chronic meningitis

Non-polio Enteroviruses

Most common is Echovirus and occasionally Coxsackie

(+) ssRNA
No envelope
Coxsackie B
Echovirus
o 24-30 nm
o 7.5 kb RNA
o Contains RNA replicase

Neisseria meningitidis

Beta proteobacteria
Gram-negative
Diplococcus
Aerobic
Encapsulated
Does not form spores
Non-motile
PIliated
Part or normal human flora in the nasopharynx

Prevention

Contain infected patients

Note any differences in behavior/appearances of tribe
members and report them as soon as possible
Treat all infections as early as possible before symptoms
worsen
Sanitize food, water, clothes, medical supplies, beds, etc
Educate tribe about the dangers, prevention, and
treatment
Inform tribe on where the nearest healthcare provider is

Treatment

Viral Meningitis
o The patient normally starts to get better within three
days of feeling sick, and will recover within two
weeks.
At home treatments include:
o Drinking extra water
o Medicine for pain, and vomiting

Treatment

Bacterial
o Immediate urgent treatment in a hospital is required
o Antibiotics are administered (pennicillin, ampicillin, chloramphernicol, ceftriaxone)
o Ceftriaxone administered in poor, less developed countries
For severe cases the patient could be in the hospital for weeks or even months. For less severe
cases, youll need to be in the hospital for about a week.
The patient will also be given:
o Oxygen
o Fluids
o Steroids or other medications may be given to reduce the swelling around the brain

Ceftriaxone Mechanism

Likely the drug that would be administered to Saihuns

father
Ceftriaxone
Targets Streptococcus pnumoniae
Inhibits:

Cell wall formation

Biosynthesis
External encapsulating structures
Bacterial physiological processes

Vaccines

There are two types of vaccines:

1. MCV4- this is approved for people ages 9 months to 55 years.
2. MPSV4- this is approved for people over the age of 55.
Both of these are effective in 9/10 people.
Meningitis is caused by many different viruses and bacteria, so there are various methods of
prevention.
There are two types of vaccines:
1. MCV4- this is approved for people ages 9 months to 55 years.
2. MPSV4this is approved for people over the age of 55.
o Both of these are effective in 9/10 people.

Other Treatments

It's possible to catch some types of meningitis through

contact with bodily fluids, so there should be limited
contact with infected patients.
Wash your hands when you come in contact with
someone who has it.

References
-

NHS (2014 October 6) Meningitis- Treatment. http://www.nhs.uk

WebMD. Preventing Meningitis: Meningitis Vaccines & More. http://www.webmd.com.

Mayo Clinic. Diseases and Conditions: Meningitis. http://www.mayoclinic.org

http://www.textbookofbacteriology.net

http://emedicine.medscape.com/article/963458-overview

http://dxline.info/diseases/cerebral-spinal-fluid-collection#prettyPhoto[pp_gal]/3/

www.mayoclinic.org/diseases-conditions/meningitis/basic/symptoms/con-20019713