4.

Clinical Aspects

Bacterial Meningitis is generally preceded by upper respiratory tract illness in adults and children when the natural habitat is the different meningococcus bacteria’s that occur in the human nasopharynx. [40] It is a non-motile, gram-negative diplococci bacterium that transfers from one host to another via direct contact with body fluids and causes various symptoms. [42;47]

The patient has the most common form of Bacterial Neisseria Meningitis with clinical features of high temperature of 40 degrees, neck supplement, fever, and headache, which indicate inflammatory activation of the trigeminal sensory nerve in the meninges and presumably can be stopped by 5-HT1B/D/F receptor agonists. [43;44] (Figure 1)

However, the symptoms of BM are often non-specific, especially at young ages as the 19-year patient and can be challenging to determine. [46] Neisseria meningitidis bacteria multiply rapidly and lead to a mild subclinical infection. In approximately 10-20% of cases, the N.Meningitis enters the bloodstream called Meningococcaemia, which usually precedes the development of meningococcal meningitis by 24-48 hours. [45]

In some cases, the collapse of the blood vessels may lead to shock and called Waterhouse-Friderichsen syndrome, when the meningococcus bacteria spread to the blood due to septicaemia. [41] Later symptoms may include paralysis of one side of the body (hemiparesis), hearing loss, or additional neurological abnormalities.

The damage of the protective membranes covering the brain and spinal cord leads to bacterial or viral infection of the fluid surrounding the brain. [48,49] As a result, the spinal cord usually causes swelling occurring cerebral edema or ventriculitis, or hydrocephalus occurring accumulation of fluid in the brain cavity. [52] Additional symptoms may include chills, sweating, weakness; loss of appetite; muscle pain of the lower back or legs; or inability to tolerate bright light. [51]

Therefore, later determination leads to more complex, minor frequency symptoms of the meningococcal disease, including neck stiffness, photophobia, petechiae or haemorrhagic rash, altered mental status, myalgia, shock, and abnormal skin colour, purpura fulminans, or even disseminated intravascular coagulation (DIC). [50] (Figure 1)

Figure 1 The table of Frequency in percent depending on different symptoms of meningococal disease. Ref. Van de Beek D, Greeff SC, Melker HE, Schouls LM, MJ Thompson.[53; 54]

Although one of the characteristic rashes is a more specific finding, it is observed in only 45% to 65% of cases at presentation. [55;56]

In addition, meningococcal rashes depend on skin type and look diverse, continually developing into a non-blanching red, purple, or brownish petechial rash or purpura, meaning it will not go away when pressed. [58]

For example, when a petechial rash appears as red or purple patches on the skin and may resemble flea bites, while the purple rash looks more like a bruise, appearing as reddish-purple patches on the skin. [57] (Figure 2)

Bacteria invade the blood vessels and organs, causing damage to them while the result is followed by leakage of blood through vessels, appearing in rashes. [59]

Figure 2. The difference between 2 types of meningococcal rashes; Santistevan Jamie, MD; JUL 18TH, 2016 [60]

Furthermore, the low platelet counts (thrombocytopenia) and several platelet function disorders increase the risk of bleeding, while the white blood was represented bacterial infections by the increased count of white blood[61;62;63] Therefore, the clinical features of Meningitis are challenging to detect and depend on different factors as age, symptoms, types of rashes, and blood test examination.

Supportive material: Animator - Sunny Rai Intro created by Ilhaam Mullagee (Music -- Longzijun); https://www.youtube.com/watch?v=FHLWnlrmKNg

References

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