Dr. Anne Ong Lim, pediatric and infectious disease expert, recalled the anxiety-inducing Friday afternoons during her fellowship days. The usual anticipation of weekend leisure was often disrupted by urgent calls from the emergency room (ER).
“We would be packing up our things, ready to unwind, when the dreaded call would come in,” Dr. Lim said. “The ER staff would report a patient with fever and rash, a suspect case of meningococcemia.“
The moment they heard that, their hearts would sink. They knew the urgency of the situation.
Meningococcemia, a severe bacterial infection, can progress rapidly, often leading to life-threatening complications within a short period. Lim pointed out the reality of the disease’s progression: “Parents would describe their child feeling unwell in the morning, only to deteriorate rapidly throughout the day. In some cases, the child’s condition would worsen dramatically, culminating in a tragic outcome within 24 hours.”
This alarming scenario, unfortunately, is common, as Lim has observed similar cases in various healthcare institutions across the National Capital Region and the entire country. The speed at which the disease can advance underscores the critical importance of prompt diagnosis and treatment.
High mortality rate
While bacterial infections are common childhood ailments, some can have devastating consequences. Among these is invasive meningococcal disease (IMD), a severe infection caused by the bacteria Neisseria meningitidis.
At an IMD forum at the Grand Hyatt Manila, Lim warned that IMD can progress rapidly, often starting with flu-like symptoms, vomiting, weakness, and rashes, and escalating to life-threatening conditions such as meningitis, a brain infection, and meningococcemia. The latter, a blood infection, can lead to limb loss, organ failure, and even death.
The challenge with IMD lies in its rapid progression and the difficulty in early diagnosis. Blood cultures, the standard diagnostic tool, can take up to 24 hours to confirm the infection. By that time, the disease may have already progressed significantly.
The mortality rate for IMD is alarmingly high, even in advanced healthcare settings. Survivors may face long-term complications such as neurological damage, learning disabilities, stroke-like symptoms, hearing loss, and kidney failure.
“The mortality rate is quite high, the batting average for even advanced care facilities here in Metro Manila is not very good. Our case fatality rate is 50 percent. Meaning, for every two patients that you diagnose with meningococcemia, one of them will die,” said Lim.
Problems don’t only happen to the brain; other organ systems are also affected. There are some that have renal failure, kidney failure, while some others, unfortunately, will need to have their limbs amputated so they can survive the disease.
Extreme cases
Dr. Lulu Bravo, a seasoned pediatrician and Lim’s mentor, cited that a hallmark symptom of IMD is the appearance of distinctive rashes. These rashes, often described as “blood-like” or “purpuric,” can quickly spread across the body. In severe cases, they can lead to tissue death and gangrene, necessitating amputation of affected limbs.
She related the harrowing case of a two-year-old patient. Within hours of admission, the child’s condition deteriorated rapidly, with the characteristic rashes spreading across the body. Despite the challenges and the fear it induced among other patients and staff, the child’s life was saved through immediate medical intervention and intensive care. However, the child did lose a finger as a result of the infection.
Another patient was not as lucky. The 18-year-old patient was hospitalized and underwent multiple amputations, but on the sixth day, she died. Her family set up a foundation for meningitis.
Bravo said meningococcal vaccination is mandated for all freshmen. “Transmission could be from kissing or from sharing bottles. Or don’t kiss or share if you’re not vaccinated,” she said.
Post-exposure prophylaxis, involving the administration of antibiotics to individuals who have been in close contact with an infected person, is another preventive measure. However, vaccination remains the most effective way to protect against IMD.
Protection
Lim cited certain groups that are recommended for routine vaccination. Aside from children, adolescents will engage in certain types of risk-taking behavior that expose them to intimate contact, including intimate physical contact and close confinement. College students living in dormitories or other communal settings are at increased risk and should consider vaccination.
Military personnel, especially those in close quarters, should be vaccinated. Individuals traveling to regions with high rates of IMD, such as the “meningitis belt” in Africa, should be vaccinated. Laboratory personnel and healthcare workers are at increased risk of exposure and should consider vaccination.
Early diagnosis and treatment are crucial for improving outcomes. If you or someone you know experiences symptoms of IMD, seek immediate medical attention. Early antibiotic treatment can significantly reduce the risk of severe complications and death.
While IMD can be a serious threat, vaccination and timely medical care can help protect individuals and reduce the burden of this disease.