Today's Editorial

Today's Editorial - 30 January 2023

A life-threatening infection

Source: By The Indian Express

Legendary rock guitarist Jeff Beck, who pushed the boundaries of blues, jazz and rock ‘n’ roll and rose to prominence as a member of the Yardbirds, passed away on 10 January 2023 at 78. Announcing the news on his Instagram handle, his team wrote, “On behalf of his family, it is with deep and profound sadness that we share the news of Jeff Beck’s passing.”

They revealed that he passed away “after suddenly contracting bacterial meningitis“. “His family asks for privacy while they process this tremendous loss.

What is bacterial meningitis?

Dr Monalisa Sahu, Consultant, Infectious Diseases, Yashoda Hospitals, Hyderabad said that meningitis refers to the inflammation of the meninges, the three layers that line the skull and the vertebral canal, covering the brain matter and the spinal cord. “The cases of meningitis are significantly high across the globe, contributing to a large proportion of morbidities and mortalities, the mortality rate being as high as 25 per cent. It is a life-threatening disorder, the inflammation can be caused by a number of factors including infectious agents like viruses, and bacteria, as well as non-infectious causes like autoimmune disorderscancers and even drug reactions,” she said.

The expert shared that people at high risk of bacterial meningitis include those at extremes of ages, like infants and the elderly, along with people with chronic medical conditions like renal failureimmunosuppressed patients like transplant recipientscongenital immunodeficiencies, people on long-term steroids, under-vaccinated individuals, excessive alcohol abusesplenectomised patients, etc.

Symptoms

Dr Sahu explained that bacterial meningitis can have a wide range of clinical presentations depending on the age and immune status of the host. Symptoms include:

High-grade fever

Neck pain/stiffness

Projectile vomiting

Photophobia

Severe headache

Dizziness

Confusion

Delirium

Irritability

What causes it?

She said that the most common bacterial causes of meningitis include Streptococcus pneumoniaegroup B StreptococcusNeisseria meningitidisHaemophilus influenzae, and Listeria monocytogenes.

“Less common causes include bacteria such as Staphylococcus aureus in patients who underwent recent surgery and have invasive devices such as central lines. Mycobacterium tuberculosis has been an important cause of meningitis in India. Escherichia coli is an important pathogen in the neonatal period,” she said.

Prevention and treatment

In all cases of bacterial meningitisappropriate antibiotics are required, mostly for a prolonged duration of 3-6 weeks and supportive care is critical. “Supportive care includes managing the airwaymaintaining oxygenationgiving sufficient intravenous fluids while providing fever control are parts of the foundation of meningitis management,” she said.

MRI of the brain – both plain and with contrast – must be done. This will usually show a leptomeningeal enhancement. Also, there are complications like an abscess in the brain or involvement of blood vessels known as vasculitis. Treatment comprises a combination of antibiotics depending on the organism suspected. Corticosteroids are also given to reduce complications due to inflammation. Usually, a CSF (Cerebro Spinal Fluid) analysis is done to determine the severity of the infection and identify the bacterium or virus responsible for meningitis,” Dr Sujit Kumar, Senior Consultant Neurologist and Epileptologist, Apollo Hospitals, Seshadripuram, Bangalore added.