Swift killer

by Henrylito D. Tacio

Jaclyn thought her five-year-old daughter, Gina, had just 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. Actually, it’s a blood infection caused by the gram-negative bacteria ‘Neisseria meningitidis, which is normally found in common throat disorders.

“It is when resistance to the bacteria is lowered that it can attack the body,” said Dr. Antonio Bautista of the Department of Health’s Cordillera epidemiology and surveillance unit

When the bacteria infect the meninges – the membranes around the brain and spinal cord – they cause 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,” writes Dr. Warren Howe 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 5:00 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 has 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.

Adults are not spared from meningococcemia. In fact, four people in Baguio City – ranging from 30 to 60 years old – have been reported to have died recently of the disease. In Polomolok, South Cotabato, a 47-year-old man afflicted with the disease, also died of it.

Neisseria 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. From there, they 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. 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 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 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 disease is not at all incurable but could be treated when detected early,” said Dr. Noel Pingoy, a specialist on meningococcemia in South Cotabato. As such, “individuals with signs and symptoms, and who have a positive history of exposure to infected individuals should seek immediate medical consultation,” urged Dr. Celia Brillantes, chief of the epidemiology and surveillance unit of Baguio City.

The disease is treated with the administration of antibiotics. Family members and those closely exposed to an infected individual, including the surviving patients, are advised to take two 600 milligrams of rifampicin tablets a day for three days. Children suspected to have contact with those who were infected were also advised to take two 40 to 50 milligrams of rifampicin tablets a day in three days. The medicine tablet can be bought over the counter in pharmacies.

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.  — ###

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