Do not ignore that stiff neck

Aug 29, 2011

MARY Nabitalo, a first-time mother, explains that her two-month-old baby first got a fever. The next day she noticed the baby’s neck had become stiff, she was irritable and refused to breastfeed. When she rushed the baby to hospital, the baby was diagnosed with meningitis.

By Agnes Kyotalengerire

MARY Nabitalo, a first-time mother, explains that her two-month-old baby first got a fever. The next day she noticed the baby’s neck had become stiff, she was irritable and refused to breastfeed. When she rushed the baby to hospital, the baby was diagnosed with meningitis.

Prof. James Tumwine, a paediatrician with Mulago Hospital, observes that meningitis is a life-threatening condition in children.
He notes that according to records, about five new cases of children with meningitis are registered daily in Mulago Hospital in Ward 16.
Tumwine describes meningitis as an inflammation of the membranes that cover both the brain and the spinal cord.

Causes

Tumwine explains that meningitis is largely caused by bacterial infection, but may also be as a result of viral infection or fungi in immune-compromised children, for example, those with HIV and those who have been on steroids.

When bacteria enter the blood, they circulate throughout the body and settle in an area with a rich blood supply. The bacteria then multiply and spread to the covers of the brain and spinal cord.

Prof. Grace Ndeezi, a paediatrician working with Mulago Hospital, explains that meningitis can also be caused by the spread of a severe infection, such as an ear infection (otitis media) or a nasal sinus infection (sinusitis).

Ndeezi adds that an infection can also occur any time following direct trauma to the head or after any type of head surgery.

“Birth defects, for example, skin opening on the back allow direct access of the bacteria to the covers of the spinal cord, causing meningitis,” she explains.
Ndeezi adds that in newborn babies, it is common, but difficult to detect when bacteria passes through the umbilical cord.

Signs and symptoms

Tumwine says meningitis develops over one to four days. However, in severe cases, a child, who looks healthy, can rapidly become seriously ill within one day.

He adds that the signs and symptoms of meningitis depend on the child’s age and are not easy to detect because children cannot communicate in the same way as adults.

Symptoms

In children younger than three months, the first symptom is the child refusing to breastfeed, vomiting, increased irritability, general body weakness and fever.

In children older than one year, the symptoms include headache, fever, altered mental status (seems confused or odd), general body weakness, convulsions, neck stiffness or pain, nausea and vomiting, .

Complications

Ndeezi affirms that if untreated, meningitis can result into death.
The complications are more likely to occur if treatment is delayed or inappropriate. They include epilepsy, hearing impairment, cerebral palsy, hydrocephalus, delayed development retardation and poor attention span, especially for school going children.

Who is prone?

Tumwine explains that children who are not immunised, those with sickle-cell anaemia, children staying in crowded places and newborn babies are at risk of getting infected.

Diagnosis
Diagnosis for meningitis is based on suspicion. “Upon suspecting that a child has meningitis, spinal cord fluid is drawn and tested. However, the only challenge with this form of diagnosis is that parents shun it because they have on several occasions observed children with meningitis dying.

Prevention

Parents or caretakers need to look out for signs of meningitis so as to seek treatment early.

“Children are brought to hospital when meningitis is in its advanced stages and have developed complications,” notes Tumwine.
He urges health workers be alert and suspect meningitis.

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