‘Doctors take precautions at first sign of meningitis’

Doctors are trained to take precautions and administer tests at the slightest suspicion their patient may have meningitis, according to public health expert Dr Julian Mamo.

Mamo, a senior lecturer in public health at the University of Malta, said that if a patient presents symptoms that lead doctors to suspect meningitis, they will seek to urgently diagnose it by means of a lumbar puncture, and treat it as soon as they can.

A lumbar puncture, or spinal tap, is the only reliable way of diagnosing meningitis once it has developed. The procedure involves the collection of a sample of cerebrospinal fluid for analysis.

The recent death of Ritianne Muscat, 32, who died of meningitis last April, has led to public concern about the condition. Ritianne's father, Raymond Muscat, has filed a judicial protest, explaining she died two days after going to Mater Dei Hospital complaining of severe earache and being sent home by the doctors who examined her.

Muscat's death certificate stated she passed away due to meningitis, and her father alleged that his daughter's doctors were guilty of gross negligence.

This news came amid reports of another case, which is currently being heard in court. The parents of Aimee Abela, 2, who died of meningitis in 2001, have accused seven doctors of misdiagnosing the disease which killed their daughter.

However, meningitis is particularly difficult to diagnose, as it often begins as a relatively mild condition, such as gastroenteritis, influenza or ear infection.

Meningitis, which refers to an inflammation of the meninges - the protective membranes which cover the brain and spinal cord - is caused when viruses, bacteria or other microorganisms cross the blood-brain barrier, which usually keeps materials in the bloodstream from entering the brain.

Because it can be life-threatening if left untreated, the condition is classified as a medical emergency.

"The body is usually well-equipped, through the immune system and natural defences, and sometimes with the aid of medicine, to fight off the initial infection. The problem begins once the infection has crossed the blood-brain barrier.

"Doctors obviously cannot pre-emptively diagnose meningitis, but once meningitis has developed, it wreaks havoc very quickly, often leaving the patient little time to seek medical attention," Mamo said. 

Mamo said it was of paramount importance that the public understood the nature of the condition, and emphasised the importance of always being on alert when one is unwell, and to keep an eye out for any symptoms which may develop in addition to the ones associated with the original illness.

Symptoms to look out for are: neck rigidity, a persistent headache, rash, fever, and sensitivity to light and noise.

"If you develop any of these symptoms, seek urgent medical help," Mamo urged.

He also strongly recommended finding a GP one is comfortable with, and to resist the urge to "shop around" unless absolutely necessary.

"Your GP will know your medical history. The more he or she knows, the better able they will be to gauge whether or not your symptoms are cause for concern."

Although meningeal irritation can be caused by any microorganism, the most common types of meningitis are viral and bacterial.

Viral meningitis tends to resolve by itself. In these cases, doctors support the patient in terms of hydration and, rarely, with antiviral medication.

Bacterial meningitis, on the other hand, and although highly treatable, is life-threatening if left undiagnosed. It is almost always fatal if not treated.

Since any number of infections can be the cause of meningitis, vaccines are not available to prevent and treat all forms of the condition. "Even if you have had a preventive vaccine, it does not necessarily mean you are immune," Mamo said.

The vaccine against hib, which commonly causes meningitis, is currently available for free in Malta, through the National Immunisation Service.

Meanwhile, according to the Directorate for Pharmaceutical Affairs, the pneumococcal polysaccharide vaccine is given free of charge to adults who may be at risk of contracting the bacteria, including splenectomy patients, transplant recipients and patients with immunodeficiency.

Close relatives and friends of a confirmed case of vaccine-sensitive meningococcal meningitis are also vaccinated for free according to the pathogen.

Most viral meningitis is caused by enter viruses, for which vaccines are not available. However, it can sometimes be caused by mumps, measles, influenza and chicken pox.

The vaccine against influenza is given free to children under five and adults over 55, and those with chronic illness. The chicken pox vaccine is not available on the free national schedule.

Also available is a vaccine against Group C meningococcus, given to infants at two, three and four months of age. Adults and children over one year of age only need one injection. However, this does not protect against the more common Group B type of meningococcus.

A vaccine against pneumococcal disease is also available, as well as the conjugate ACYW135 meningococcal vaccine, which is usually administered before travel to high endemic areas.

According to Prof. Thomas Attard, president of the Maltese Paediatric Association, when it comes to newborns and babies up to three months old, doctors will suspect meningitis every time a child is ill.

"They always prefer to err on the side of caution," he said.

Attard also recommends consulting the GP each time a person is ill. "This is especially important when it comes to children or people whose immunity may be compromised due to disease or medication," he said.