ASK THE DOCTOR: Bacterial meningitis is rare
By DR. JIM MITTERANDO
The Patriot Ledger

A recent death of a local South Shore teenager from meningococcal meningitis and sepsis has recently caused quite a bit of alarm as well as questions. This article is intended to answer questions about meningitis as well as provide reassurance that most people in contact with someone with meningitis are not at risk and do not require preventative antibiotics.

Meningitis, an infection and inflammation of the membranes and fluid surrounding the brain and spinal cord, causes severe headaches, high fever, sensitivity to light and a stiff neck.

Most cases are viral, and neither contagious nor life-threatening. Viral meningitis typically occurs in the summertime and particularly effects young children. Bacterial meningitis most commonly occurs in the late winter and early spring. Bacterial meningitis is a rare but contagious and potentially lethal disease.

Whereas the bacterial form of the disease requires intravenous antibiotic therapy, viral meningitis resolves without treatment.

It is important to diagnose and treat bacterial meningitis early to prevent brain damage or death. Diagnosis usually is made by growing bacteria from a sample of spinal fluid.

Distinguishing viral from bacterial meningitis requires a procedure called a spinal tap, which involves inserting a needle between the vertebrae in the lower back and collecting spinal fluid.

Meningococcal meningitis, a form of bacterial meningitis, mostly effects children and kills rapidly in about 10 percent of cases. It is rare, affecting 1 in every 100,000 people. There have been no recent epidemics of meningococcal meningitis in New England. The heightened news coverage of sporadic, isolated cases of meningitis gives the illusion that this disease occurs commonly. Approximately one meningococcal infection occurs on the South Shore every year.

People who come in close contact with someone who has meningococcal meningitis are at increased risk of developing meningitis. Close contacts can protect themselves with a preventative antibiotic prescribed by their doctor. Close contact examples include being exposed to someone with meningococcus that lives in the same household; attends the same day care or child care or was exposed to their saliva through kissing, sharing toothbrushes or eating utensils.

People with casual contact such as a schoolmate or co-worker are not at increased risk of meningitis and do not require preventative antibiotics. If you have not had direct contact with the person with meningitis, you are not at risk (i.e. If you had contact with a family member of the person with meningitis.)

Rifampin and Ciprofloxacin are the two antibiotics commonly prescribed to prevent meningococcal meningitis. In the past, Ciprofloxacin was not prescribed for children because of concerns of potential damage to cartilage that was observed in young laboratory animals. This damage does not occur in humans and can be safely used in children.

Rifampin can cause orange urine and stools as well as stain contact lenses. Rifampin may interfere with birth control pills and seizure medications.

As with all antibiotics, they can cause diarrhea and yeast infections.

Dr. Jim Mitterando is a family doctor at Health Care South/Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2002 The Patriot Ledger
Transmitted March 26, 2002