Want to know exactly what Meningococcal Disease is? Let's talk about it!

There are some diseases that sound a little scary even when you hear their name, don't you think? Today we are going to talk about a disease that is a little serious, but can be controlled if you are aware of it in advance. This is called meningococcal disease. Don't worry, let's talk about everything clearly.

What is Meningococcal Disease?

Simply put, meningococcal disease is a bacterial infection . It is caused by a bacterium called Neisseria meningitidis. It is sometimes called meningococcus. This bacterium can infect the protective membranes that surround our brain and spinal cord (called the meninges) and the blood . These infections are very dangerous and can sometimes be life-threatening . When the meninges are infected in this way, it is called meningococcal meningitis, and when the blood is infected, it is called meningococcal septicemia (like blood poisoning).

To explain the term `meninges` a little more, it means our Central Nervous System , that is, the three membranes that surround our brain and spinal cord. Just like the delicate membranes that separate the pith of an orange, these also provide protection to our brain and spinal cord. In fact, our skin is the largest protective membrane in our body. These three meninges are the pia mater, the arachnoid, and the dura mater.

What is the difference between meningococcal disease and meningitis?

Now you may be thinking, 'So, are meningococcal disease and meningitis the same thing?' Yes, there is a slight difference. Meningococcal disease is caused by the specific bacteria that we mentioned earlier, Neisseria meningitidis . However, 'meningitis' is a general term for any condition that causes inflammation of the membranes (meninges) around the brain . So, meningitis can occur in meningococcal disease. However, not all meningitis is caused by the bacteria that cause meningococcal disease. Meningitis can also be caused by other viruses, bacteria, and fungi, get it?

Who is most affected by meningococcal disease?

Although anyone can get meningococcal disease, some people are at higher risk of developing it. Let's take a look at who they are:

• By age group: Infants under one year of age, young adults (especially those between 16-23 years of age), and young adults. The risk is even higher if these age groups are exposed to secondhand smoke (passive smoking or active smoking) .
• Foreign travel: For those traveling to certain countries where meningococcal disease is prevalent.
• Health conditions:
• People who do not have a spleen or have damaged spleens (the spleen is an important organ in our immune system).
• People with sickle cell disease.
• People with certain weaknesses in their immune system, especially those with problems with a part of the immune system called ``Complement.''
• People taking drugs called ``complement inhibitors`` (for example ``Eculizumab (Soliris®)`` and ``Ravulizumab (Ultomiris™)``) used for certain rare medical conditions.
• Lifestyle and environment:
• For those who live in places where many people live close together, such as university dormitories and military barracks. Just think, when there are several people in one room, germs can easily spread through a cough or sneeze, right?
• People who are exposed to the disease during an outbreak.
• For those who work with this bacteria in research laboratories.

How common is this disease?

In countries like the United States, the number of cases of this disease has gradually decreased since the Second World War. In 2019, only 371 cases were reported there. However, small outbreaks can occur from time to time, especially among people living in close proximity. Doctors in Sri Lanka are also paying attention to this disease, because it can spread quickly. Therefore, it is very important to be aware of the symptoms.

What are the signs and symptoms of meningococcal disease?

There are many symptoms of this disease. If you have any of these, you should see a doctor immediately. It is very important to diagnose the disease quickly.

The main symptoms may be:

• I'm getting a high fever .
• I have a severe headache .
• Stiff neck . This is a common symptom associated with meningococcal disease and meningitis. It can feel like you can't bend your neck forward, and it can be painful when you try to tuck your chin to your chest.
• It becomes difficult to look at bright light , and the eyes seem to turn blue. This is also called ``Photophobia``.
• Nausea, vomiting and/or stomach upset and diarrhea may occur.
• A rash appears on the skin that looks like small red or purple dots . These do not turn pale when pressure is applied (a non-blanching rash). Sometimes these can become large and look like bruises. This is a very specific and dangerous symptom.

In addition to this, some other characteristics may also be shown:

• The food is tasteless.
• Feeling confused or irritable.
• I always feel sleepy and it's hard to wake up.
• Pain in muscles and joints.
• There is a sound like snoring, groaning.
• It becomes difficult to walk or stand upright.

Younger babies may show these symptoms differently. For example:

• They don't want to drink milk and they vomit.
• The body becomes twitchy or floppy.
• Excessive tiredness, constantly trying to sleep, difficult to wake up.
• Crying in a high-pitched tone (high-pitched cry).
• The soft spot on the top of the head (fontanelle) may become swollen and hard.

What causes meningococcal disease?

As we mentioned earlier, meningococcal disease is caused by a bacteria . It is a contagious disease . It is spread from person to person through respiratory secretions (mucus/respiratory droplets) . Simply put, this germ can be spread when someone who has the disease coughs, sneezes, or comes into close contact with someone who has the disease (for example, eating from the same plate, drinking from the same cup, or kissing).

Important: The bacteria that cause meningococcal disease cannot survive for long outside the body. Therefore, it is unlikely to be spread from surfaces such as tables and chairs. However, it is best to be careful with items such as handkerchiefs and tissues that have been used by the patient.

How is meningococcal disease diagnosed?

Meningococcal disease can sometimes be difficult to diagnose because its symptoms can be similar to those of other illnesses, such as the common cold or flu . Therefore, to confirm the disease, a doctor needs to find the bacteria Neisseria meningitidis.

So, the doctor usually does:

• A blood sample is taken and tested.
• Sometimes a lumbar puncture (Spinal Tap) is done. This involves taking a small sample of the fluid around the spinal cord (cerebrospinal fluid - CSF) and testing it. This may seem a little scary, but it is very important for diagnosis. This is because it can directly see if bacteria are present in the fluid.

These samples are sent to a laboratory to see if the bacteria can be grown (cultured). If the bacteria grow, the disease can be confirmed. If these tests are not clear, the doctor may order further tests.

How is meningococcal disease treated?

Meningococcal disease is treated with antibiotics . If your doctor suspects you have the disease, they may start you on antibiotics even before they can confirm the diagnosis. It is very important to start treatment as soon as possible. These antibiotics are usually given as intravenous antibiotics, which can help you get results quickly.

In addition to antibiotics, other supportive treatments may be needed depending on the patient's condition. For example:

• If there is difficulty breathing, oxygen therapy may be given , possibly even connecting to a ventilator.
• If blood pressure is low, give medication .
• Controlling body fluid levels.
• Sometimes, if the skin is damaged and the tissue has died, surgery may even be necessary to treat it.

Complications associated with meningococcal disease

This is a very serious disease . Even with treatment with antibiotics, 10 to 15 out of every 100 patients will die . Also, about 20% of those who recover from the disease may develop long-term effects . These include:

• Deafness
• Limb loss, especially if the septicemia becomes severe.
• Nerve damage
• Kidney damage
• Brain damage can cause conditions such as learning disabilities, memory impairment, and epilepsy.
• Skin scarring.

It can take some time to fully recover. Antibiotics are usually given for 7 to 10 days. However, it can take longer for you to fully recover, especially if you develop complications.

How can you reduce the risk of contracting meningococcal disease?

There are several things we can do to protect ourselves from this dangerous disease.

1. Get Vaccinated

In countries like the United States, there are two types of vaccines against meningococcal disease. In Sri Lanka, you can also get medical advice on this. It is especially good for those in high-risk groups (e.g., infants under one year old, young adults, people living in dormitories, and those with certain health conditions) to talk to a doctor about these vaccines. This vaccine may be mandatory when traveling to some countries.

2. Take Preventive Antibiotics if needed

If you are taking medications such as the ``complement inhibitor'' we mentioned earlier, your doctor may advise you to take antibiotics to prevent meningococcal disease while you are taking those medications. These ``complement inhibitor'' medications are usually given for rare conditions such as:

• `Atypical hemolytic uremic syndrome` (This is a blood-related disease)
• Paroxysmal nocturnal hemoglobinuria (this is also a blood disease)
• Generalized myasthenia gravis (this causes muscle weakness)

Also, if you live with someone who has meningococcal disease or have been in close contact with them (e.g., in the same household, in the same class), your doctor may also tell you to take antibiotics as a preventative measure (preventive antibiotics / chemoprophylaxis) . This is to kill the bacteria if they are already in your body, prevent them from developing the disease, and stop you from spreading it to others.

3. Practice avoidance and infection prevention

In general, stay away from people who are sick, especially those with a fever or cough, whenever possible . Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer when soap and water are not available. Avoid touching your eyes, nose, and mouth with unwashed hands. Cover your mouth and nose with a tissue or your elbow when coughing or sneezing. These are common health practices, but they can also help protect you from dangerous illnesses.

What can you expect if you contract meningococcal disease?

Meningococcal disease is a very serious condition . It can lead to `Meningococcal Meningitis` or `Meningococcal Septicemia`. It can even be fatal . Therefore, it is essential to seek treatment as soon as possible .

Antibiotics may be started before the doctor can confirm that you have meningococcal disease, as early treatment increases the chance of a full recovery.

Even with treatment, some complications can occur. This can lead to permanent damage to the skin or internal organs. Or, it can lead to temporary complications, such as difficulty concentrating.

Importantly, unlike some other infections, meningococcal disease can be contracted more than once in your life. Having it once does not give you lifelong immunity. If you have had it more than once, your doctor may want to test your immune system.

When should you see a doctor if you suspect you have meningococcal disease or have symptoms?

If you have symptoms of meningococcal disease, or suspect you have it, you should see a doctor immediately, without delay. This should be treated as an emergency.

If you experience any adverse reactions to the treatment, or if you feel your symptoms are getting worse, tell your doctor immediately.

Although some of the symptoms of meningococcal disease, such as fever and body aches, can be similar to other less serious illnesses, it is important to recognize and treat the disease quickly because it can become serious very quickly. If you or your child has any of these symptoms, especially a stiff neck, fever, and skin rash , be sure to see a doctor. Getting vaccinated is one of the most important steps to prevent this.

The most important things we need to remember from this story (Take-Home Message)

Okay, so now you have a better understanding of what we've been talking about, meningococcal disease. Remember:

• Meningococcal disease is a very serious, rapidly spreading infection caused by bacteria .
• Fever, severe headache, stiff neck, and red/purple spots on the skin (especially those that do not turn pale when pressed) are the main warning signs. If you see these , seek medical attention immediately . Time is of the essence.
• Early diagnosis and antibiotic treatment are crucial to saving lives and reducing long-term complications.
• Vaccination is the best way to protect yourself from this disease, especially for those in high-risk groups. Talk to your doctor about this.
• Personal hygiene (washing hands frequently, covering your mouth when coughing/sneezing) and staying away from people who are sick are also important.
• Rather than being afraid of this disease, it is wise to be properly informed and take the necessary steps . If you or someone in your family has questions about this, never hesitate to talk to a doctor.

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