BALTIMORE – The kidney-shaped cells of Neisseria meningitidis cling together, seeming to decide as a colony where to attack the body.
If they approach the bloodstream, the first symptoms will be a stiff neck, high fever and severe headache that won’t go away. Most of the time, a red-dotted skin rash appears.
The illness is bacterial meningitis, an infection of meninges, the lining around the outside of the brain. Nationwide, six of 100,000 people are diagnosed with the disease annually, health officials say.
In the first two months of 1997, bacterial meningitis cases in Maryland increased to 15, compared to last year’s 11 through January and February. Should the incidence continue at this pace, there will be 90 cases this year. That rate is behind the national average, but significantly ahead of last year, when the state had 61 cases.
Bacterial meningitis has claimed the lives of at least two Marylanders in 1997. Sheronda Conaway, 20, a cheerleader at Morgan State University, died Feb. 21 in her dorm room. State health officials have confirmed a second death, but have not yet released details. Meanwhile, they are investigating the death March 2 of 2-week-old Ma’Kayla C. Brown of Annapolis.
Dr. Michelle Leverett of the Baltimore County Health Department said no one can explain the increase in cases this year.
“The fact that the cases have been unrelated is encouraging,” Leverett said. “Most people are not at an increased risk of getting the infection. It cannot be contracted by casual contact and it is not airborne.”
The bacteria are spread via saliva or mucous — by sharing dishes or utensils, by kissing or by unthinkingly placing a hand to the mouth immediately after it has touched a contaminated surface.
According to the Maryland Department of Health and Mental Hygiene, close contacts of a patient with known bacterial meningitis have as much as a 1,000 times greater risk of developing the disease than others. A close contact is defined as someone who eats or sleeps with an infected individual.
Even so, not everyone who carries the bacteria will get the disease.
Dr. Katherine Farrell of the Anne Arundel County Health Department said there is a higher risk in crowded situations. However, she said, even then 50 percent of people may carry the bacteria, but only a handful get the disease.
“By overcrowding, I don’t mean just two people in a room — it has to be a lot of people in a small living space,” she said. “It is transferred by droplets from one person to another. The more crowding, the more chance of picking it up.”
Farrell said knowing the symptoms is especially important now because spring is the disease’s peak season.
“The sudden onset of severe headaches and a stiff neck usually means some form of meningitis,” Farrell said. “Along with a fever, these symptoms are a real danger sign.”
In February, a Loyola College student, Richard Galasso, 22, became ill from the disease, but his roommate recognized the symptoms and rushed him to a hospital.
However, infection control officers and hospitals are the more common source of detection, Farrell said.
The test procedure requires a lumbar punch, or spinal tap, to obtain spinal fluid. “If the test is positive for bacteria, it might indicate infection,” Farrell said. “Blood will also be tested for a blood infection.”
Most tests for patients who have the symptoms are taken at hospitals or private physician’s offices. Once a test reads positive, the local health department is notified. Afterward, the sample is sent to the State Public Health Laboratories in Baltimore to double check its positive status. There are nine different types of bacterial meningitis, and the state lab does all the final testing and typing.
But hospitals don’t wait to begin treatment.
“We put the individual in isolation for the 24 hours after the start of the medication,” Farrell said. “Then we contact the intimate family members, boyfriend or girlfriend, and occasionally health care providers, which is very rare, and give them prophylaxis, a treatment that prevents disease development.”
The most frequent choice of medication is rifampin, an antibiotic.
There are two types of meningitis: viral and bacterial. Bacterial is the more dangerous form, given the suddenness of its symptoms, Farrell said.
“If I had those symptoms I might think I had a case of the flu,” she said. “Don’t ignore the symptoms…. Get medical help.” -30-