Meningitis can move quickly

On Call

March 18, 1997|By Dr. Simeon Margolis | Dr. Simeon Margolis,SPECIAL TO THE SUN

Can you explain why college students have been dying of meningitis? Can anything be done to prevent it?

Meningitis results from a progressive inflammation of the membranes surrounding the brain. Although meningitis can be due to infections by a number of different viruses, bacteria and even fungi, meningococcus bacteria (Neisseria meningitides) is the most likely cause of the recent deaths described in the newspapers.

At some time in their lives, almost all people harbor these bacteria in their nose and throat without producing any symptoms or illness. During such periods, the majority of people develop protective antibodies against the organism. The bacteria can enter the bloodstream, but are usually quickly destroyed when antibodies and the immune system function properly. If not destroyed, the bacteria can spread, especially to the membranes around the brain.

Meningococcal meningitis is most common in infants and in young adults. The disease occurs predominantly in the winter even though 15 to 25 percent of teen-agers carry the bacteria in their nose and throat at all times of the year. The organism is transmitted from person to person in airborne droplets. Epidemics of meningococcal meningitis once were common among military recruits because large numbers of young adults from different parts of the country ate, slept and trained together. College students are now especially prone to develop the disease for some of the same reasons.

Because few infections progress as rapidly as those due to the meningococcus bacteria, it is essential to get prompt medical evaluation for any symptoms suggestive of meningitis. Despite the availability of effective antibiotics, between 5 and 15 percent of cases are fatal.

People who develop meningococcal meningitis may have a preceding upper respiratory infection. Most often, however, the disease begins without warning. Symptoms, which can become severe within 24 hours, may include headache, lethargy, fever, vomitting, irritability, confusion progressing to delirium and stupor, seizures and a stiff neck. A characteristic of bloodstream invasion by meningococcus is the presence of multiple, pinpoint, red spots (petechiae) in the skin.

Effective vaccines are available against most types of meningococcusk and their routine use in all U.S. military recruits has nearly eliminated outbreaks in the military. Otherwise, vaccination is recommended only for travelers to places where there is an epidemic of meningococcal disease, individuals with certain immune deficiencies, and for close (household) contacts of those who have come down with meningococcal disease.

Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

Pub Date: 3/18/97

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