The Department of Health (DOH) has confirmed the first case of meningococcemia in Central Visayas, according to reports from the Philippine Daily Inquirer and Philippine Star. (http://m.inquirer.net/newsinfo/id=632975 and http://www.sunstar.com.ph/cebu/local-news/2014/08/27/resu-7-confirms-)
A man, whose identity was withheld by the DOH, died on August 16, just three days after being brought to hospital complaining of high fever, vomiting and rashes; his speech later became slurred. The man was initially taken to the Danao City Provincial Hospital. When his conditioned worsened, he was transferred to the Vicento Sotto Memorial Medical Center in Cebu City where he expired.
Relative, neighbors and other people who were in contact with the man before he died are being monitored by the DOH and have been given prophylactic antibiotics as a precautionary measure. The DOH has also advised the hospital personnel who came in close contact with the man to undergo medical evaluation.
Meningococcemia is sudden and deadly
Meningococcemia is a sudden, severe and potentially life-threatening infection of the bloodstream. It is caused by Neisseria meningitidis, a type of bacteria that often live in the nose, mouth and throat without causing visible signs of illness. The bacteria can be spread from person to person through respiratory droplets expelled when an infected individual sneezes or coughs. Family members and people closely exposed to persons with the infection are at increased risk.
Early symptoms include fever, headache, irritability, muscle pain, nausea, vomiting, and rash with red or purple/blue spots (petechiae), which are actually areas of bleeding under the skin caused by ruptured blood vessels
Later symptoms may include changing level of consciousness, large areas of bleeding under the skin resulting in huge purplish/bluish spots (purpura), and shock.
In meningococcemia, the bacteria attack the blood vessels, causing them to rupture and leak. Massive damage to blood vessels leads to insufficient blood supply, low blood pressure and reduced cardiac output. Without prompt treatment, multiple organ failure, shock and death can quickly ensue.
Meningococcemia is a medical emergency. Patients are often admitted to the intensive care unit (ICU) for close monitoring. They may be placed in isolation for the first 24 hours to help prevent the spread of infection. Intravenous antibiotics are among the first-line treatments.
According to Dr. Xenia Jaramillo Fabay, a pediatric infectious disease specialist from the Baguio General Hospital and Medical Centre said that literature review will show us that the right antibiotics given within 24 hours of the manifestation of meningococcal disease can actually save lives. “And this was proven in our actual clinical experience during the outbreak in the Cordilleras which begun in the last quarter of 2004. However, specialists agree that the prognosis of this menace is dependent upon the precise timing of medications, which we have to admit as healthcare workers, is not a guarantee to prevent death.” she said.
CAR, 2005: country’s largest meningococcal disease outbreak
In her presentation, Dr. Fabay said that the two most common presentations of meningococcal disease are meningococcemia and meningococcal meningitis. She noted that patients may present with one or both.[pq]Meningococcal meningitis causes inflammation and irritation of the meninges, the membranes surrounding the brain and spinal cord. It can block blood vessels in the brain, which can lead to a stroke and brain damage. It can also damage other organs.[/pq]
According to Dr. Fabay’s presentation, there have been several outbreaks of meningococcal disease in the Philippines. In 1988, 36 cases were reported in Mindanao. Ten cases were reported the following year in Negros Occidental. From 2002 to 2004, a total of 101 patients with meningococcal disease were confined in San Lazaro Hospital.
Twenty-nine cases were reported in the Cordillera Administrative Region (CAR) in 1993, a single case in 1995, two in 1998, and 36 in 2004. In February 2005, a meningococcal disease outbreak affecting a total of 376 patients occurred in CAR. Almost half of the patients were 5 years of age and younger. About a third of the patients died.
According to Dr. Fabay’s scientific article “Terror in the Air: Meningococcal Disease Outbreak in the Philippines”, the CAR epidemic was the first documented meningococcal disease outbreak north of the National Capital Region and the largest recorded outbreak in the history of the Philippines.
Dr. Fabay’s article won third prize in the 2007 Poster Contest of the Pediatric Infectious Disease Society of the Philippines (PIDSP). It was published in the January-June 2010 issue of the PIDSP Journal. (http://www.pidsphil.org/pdf/Journal_01242011/jo36_ja03.pdf)
A vaccine that helps protect children and adults against meningococcal disease is available. Talk to your doctor about the meningococcal vaccine that’s right for you and your loved ones.
– Eric Michael Santos, Medical ObserverReferences: