O Dimie, O Reginald, N Kuffrey, A Mohammed, I Henry, B Isa
africa, meningitis, meningococcemia, neisseria meningitides
O Dimie, O Reginald, N Kuffrey, A Mohammed, I Henry, B Isa. Acute Meningococcemia Complicating Epidemic Meningitis In Zaria, Nigeria. The Internet Journal of Tropical Medicine. 2009 Volume 7 Number 1.
A 20year old male petty trader (Case 1), a 13year old female pupil (Case 2) and a 16yr old female student (Case 3) each, presented with acute symptoms of headache, fever, vomiting and neck pain associated with microscopic haematuria, haemorrhagic skin lesions, meningeal irritation, oliguria as well as hypotension and altered consciousness. Case 1 had petechaie and purpuric lesions on the right foot while Case 2 had similar lesions on her upper and lower limbs. Both of these patients had mild thrombocytopenia and prolonged international normalised ratio of 2.0. Case 3 had different degrees of purpura, blisters and ulcers all over the body, in addition to recurrent generalized seizures, papilloedema, coma and septic shock. She was bleeding from mucosal orifices with laboratory features of disseminated intravascular coagulation (DIC) (platelet counts of 62 X 109/L, normal range 100-400 X 109/L, prolonged prothrombin time by 8s above control and prolonged Kaolin cephalin clotting time by 17s above control).
Gram negative intracellular diploccoci were identified from the cerebrospinal fluids (CSFs) of the patients but
Patients were treated with intravenous fluids, dexamethasone 24mg/day in divided doses, and ceftriaxone 2g daily for 3 weeks. While Cases 1 and 2 recovered in the general ward and were discharged without sequelae up to 3 months of follow-up, Case 3 had to be managed in intensive care unit (ICU) with additional transfusions of two units of fresh whole blood. On the 10th day of treatment, she developed bilateral sterile knee arthritis. However, she recovered after 86 days of hospital care and was discharged with residual bilateral knee arthralgia which persisted 3 months post-discharge.
The features of hemorrhagic skin lesions, septic shock, DIC and acute renal failure seen in these patients with meningitis are consistent with acute meningococcemia (
All the patients reported lived in overcrowded poor rural environment which are known risk factors for epidemic meningitis. While some of the risk factors for meningococcemia, such as sickle cell disease, asplenia and HIV infection, were excluded in our patients, investigations for the role of other risk factors, such as complement deficiency, properdin deficiency and polymorphisms of various inflammatory mediators (
Acute meningococcemia is a potentially fatal condition with mortality ranging from 10-43% and occurring mainly within the first 12 hours of presentation (
In conclusion, to avert the morbidity and mortality associated with epidemic meningitis in Nigeria, strengthening of surveillance measures, improvements in vaccination strategies and tackling the prevailing problems of poverty and overcrowding, are imperatives.