What is the organism which caused meningitis outbreak?

Prof. Nadaraja Bathirunathan visiting Professor Department of Transfusion Medicine MGR Medical University Chennai, India speaking to the HealthWatch on the recent outbreak of Meningitis at the De Zoysa Hospital for Women in Colombo posed the question - what is the organism which caused this outbreak?

He said "I came to this country last week on a short visit, and was surprised to read in the press of the outbreak of Meningitis at De Zoysa Hospital for Women the resultant deaths and the closure of the hospital's operating theatre.

Everybody seems to be confused as to how this outbreak occurred.

How patients get meningitis

Patients usually get meningitis by way of droplet inhalation of organisms to which they are susceptible from another patient or carrier in close contact. Here they are attributing the meningitis to some syringes and surgical instruments from an tsunami supply of medical aid.

The investigation should have been simple and straightforward. What is the organism which caused this outbreak?

Are the same organisms found in any of the syringes or surgical instruments donated as tsunami aid. And of course treatment of meningitis without knowing the actual organism causing the condition is blind and very unsatisfactory.

Speaking generally on meningitis he explained.

Our brain

Our brain is the most complex system in the whole universe. It makes us, what we are and obviously the most important organ in our body.

This vital organ is covered by membranes, the meninges, and suspended in a fluid called the cerebrospinal fluid (CSF) for maximum protection. When infected by microbes the meninges get inflamed and the person develops meningitis.

Meningitis is a very serious condition. Lot of pus is formed in the CSF and this can compress and damage the brain causing death. Meningitis develops with the symptoms of any infection: Fever, chills, shivers, nausea and vomiting, severe headache accompanied by cerebral symptoms, rigidity of the neck, slurred speech, clouding of consciousness etc.

When a doctor suspects meningitis he draws a small amount of the CSF from the spinal cord in the lumbar region, for laboratory investigation. The laboratory report plays a central role in the diagnosis and treatment of meningitis.

The technician looks for white blood cells, bacteria or fungi in the CSF and determines glucose and protein content. Meningitis can be due to bacteria, fungi, viruses and also tuberculosis. The CSF shows different pictures depending on the offending organism. e.g. in bacterial meningitis there is a high predominance of neutrophils, low glucose, and high protein content and of course, the bacteria.

Laboratory report

In a good hospital the doctor treating the patient should be able to receive the laboratory report within half an hour of providing the CSF specimen, and the treatment is initiated or modified on the basis of this report.

The CSF is cultured and in a day or two the organism is identified and its antibiotic sensitivity determined, both for immediate treatment and also as a valuable record for disease management in the hospital. In fact the microbiologist and the physicians should be aware of the common organisms causing this condition in the hospital. Ordinary diagnosis is usually quick and easy.

Bacteria

The usual Bacteria are pneumococcus, meningococcus, and haemophilic influenza and a good technician would be able to get an idea from the Gram stain. Of course, any organism can cause meningitis e.g. E-coli, Klebsiella, Salmonella, Staphylococcus etc. and the laboratory should provide this information.

Fungi

There are some fungi which cause meningitis e.g. cryptococcus, histoplasma, and even candida in immun-ocompromised patients e.g. AIDS. This rare viral meningitis is usually mild and show a high lymphocyte count in the CSF. The organism is not visible under the microscope and more sophisticated identification methods are employed.

Care of the injured and critically ill - Part II

Continuation from last week's lead story
 

by Dr. Shirani Hapuarachchi

"I am a great believer of Prevention better than cure. What can we medical personnel do in this regard.

The common causes of road traffic accidents have been shown to be due to -

(a) Improper overtaking,

(b) Driving after taking liquor,

(c) Excessive speeding.

In fact it has been reported that deaths in motor cyclists and pillion riders following the use of helmets have reduced. Pedestrian deaths too have reduced. Both these can be attributed to good education by the traffic police, introducing road regulations to the school curriculum and so on.

But there are many more preventive measures to be carried out. Spot fines by the traffic police a very simple procedure that will not only discipline drivers but earn a revenue to the Police Department.

Prevention does not mean preventing accidents alone but preventing morbidity and mortality following an accident. This is where we have concentrated our thinking and have put into action very many plans.Injuries when sustained can be broadly divided into two categories:

1. The Primary injury that takes place at the time of the impact. As for this there is nothing we can do except the preventive measures that I highlighted and are being carried out commendably by the city traffic along with the Colombo Municipal Council and the Education Department.

2. The secondary injury - this is the worsening of the existing injury due to causes other than the impact.

What are these causes - deprivation of Oxygen, accumulation of carbondioxide and non-respirable acids. Improper transport, further aggravating the injury.

A survey done in the Accident and Emergency Unit of the National Hospital showed that the majority of accident victims are brought to hospital in three wheelers.

And as you are well aware this is the worst mode of transport especially for an unconscious patient, patient with head injuries and of course to the spinal patient whose only chance of survival is also reduced to a minimum.

Our priority is to reduce the morbidity and mortality associated with road traffic accidents and if we are to do this we need to put a trauma care system into action.

This should consist of 1. prehospital care, 2. proper evacuation and transport of the injured, 3. resuscitation and primary trauma care, 4. definitive care in a trauma centre if necessary, 5. rehabilitation of the disabled 6. and quality management of the system.

What about the future

The development of a National policy for the prevention and control of injury should be the aim. This depends on information about the cause of death following injury.

In our country this should not be a problem as all deaths following injury has to be medically certified following a postmortem which will indicate the cause of death. This therefore will be of immense use.

More specifically knowledge of risk factors for injury should be studied. This will allow targeted prevention strategies. Eg. Deployment of seat belts, safer highways, air bags, geo mapping of areas with increase incidence of accidents, improving safety devices and design of vehicles to prevent fatal injuries.

It has been found that lower extremity injuries have increased dramatically because passive restraints such as seat belts and air bags have enabled vehicle occupants to survive otherwise fatal crashes.

On the other hand deaths have been reported from air bags in otherwise survivable crashes. Hence the need to improve on passive restraint devises so that they be made risk free.

Telemedicine in the use of trauma and emergency medical services is being evaluated in the developed world.

This will assess how well a remote decision-maker can detect, and decide on interventions made by on site care providers.

Provision of Fax machines in ambulances to provide clinical information to the trauma centre before patient arrival is also being looked at in the US.

It is being studied whether this will change the preparedness of the receiving team, whether it will increase the speed of reaching a definitive diagnosis and whether it will result in consultants such as Neurosurgeons and orthopaedic surgeons to be made available on time.

Finally 5.1 million deaths occur each year in the world from injury. It has been predicted that road traffic accidents which was the 9th leading cause of death worldwide in the year 1990 will be the second most important public health problem in the world by the year 2020.

We in Sri Lanka who already are witnessing a tremendous rise in road traffic accidents need to address this issue as we are bound to see an even greater number of high impact accidents with the advent of highways and express ways.

Compiled and co-ordinated by Edward Arambewala

SLMA in Career Guidance for Junior doctors

The Sri Lanka Medical Association will conduct a seminar on career guidance for junior doctors on Sunday August 28 at the SLMA Auditorium.

Dr. Maxie Fernandopulle, Chairman, Health Management Committee SLMA in a statement to the Healthwatch states:

The objective of the seminar is to help the junior doctors to decide which branch of the medicine they should choose as a career. 22 medical consultants from the different specialties will make presentations in each of their specialties. The topics will cover all branches of medical specialties both curative and preventive, medical administration, Ethics and spiritual health, the present cadre and the classification of hospitals in the state sector.

The contents of their presentation will include the vacancies and job opportunities available in each speciality in the state, the private sector, Universities and other organisations both locally and abroad. The details of the different training programmers, the entry criteria for the different courses, and the structure of the exams conducted by the Post-graduate Institute of Medicine will be discussed.

This seminar is targeted for the medical graduates qualified both abroad and locally and awaiting internship appointments and those who have still not decided on their career.

Those interested are requested to register at the SLMA office early.

From the WHO Office in Colombo

Sri Lanka to host two WHO Regional meetings

Sri Lanka will host two meetings of the WHO South East Asian Region next month, September in Colombo.

This will be the 23rd meeting of the Health Ministers of the countries in the region and the 58th meeting of the WHO SEA Regional Committee.

Both meetings will be jointly inaugurated on September 4 at Ceylon Continental Hotel, Colombo.

Among the technical subjects to be discussed at the Regional Committee meeting are:

1. Health action in emergencies, including response to earthquakes and tsunamis and

2. International Health Regulations 2005 (which impact many other sectors besides health, like trade, commerce, travel and tourism)

3. Asia-Pacific Strategy on Emergency Diseases (including the pandemic potential of diseases like Avian influenza) that has impacted the health and economies of several countries in the region.

(Sent to HealthWatch by Susie Derilliers Crisis Communication and Media Relations Officer, WHO Colombo)