What You Need to Know about Cerebrospinal Meningitis (CSM)

The first case of Cerebrospinal Meningitis in Ghana was recorded in 1,906 in Cape Coast among labourers brought from East Africa to support the British in a war against the Ashantis.  It later spread to other countries in the West African Sub Region. Countries such as Burkina Faso, Chad, Ethiopia and Niger have all recorded cases of CSM. In Ghana all regions have recorded cases of CSM but the highest number of cases occur in the Northern Regions especially during the dry season. Residents of the Northern Regions have been plagued with Cerebrospinal Meningitis (CSM) annually.

According to the Mayoclinic.org CSM is the inflammation of the membranes which surround the brain and the spinal cord that may be life threatening. According to the World Health Organization also, CSM  is caused by different pathogens which include viruses and fungi. However the highest occurring incidence of meningitis worldwide is caused by bacteria and survivors may as a result of the disease suffer from focal neurological deficits, hearing loss, cognitive impairment and epilepsy which has considerable economic and social costs.

Symptoms of CSM, according to the WHO, are a stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. Even with early detection and onset of adequate treatment of the disease, WHO says 5% to 10% of patients die, typically within 24 to 48 hours after the onset of symptoms.

How is CSM Transmitted?

Transmission of CSM is from person-to-person and this may be through droplets of respiratory or throat secretions of infected persons or those who carry the pathogen. Contact either close or prolonged activities such as kissing, sneezing or coughing on someone, or living in close quarters (such as a dormitory, sharing eating or drinking utensils) with an infected person aide in the spread of the disease. The disease has an average incubation period of four (4) days, but can range between two (2) and ten (10) days.

Treatment

Treatment of this potentially fatal disease should be done with urgency. With a similar disease like COVID-19 where isolation is necessary, it is not the same in case of meningitis, however being admitted to a healthcare facility is necessary. This will enable health professionals to carry out a lumbar puncture or spinal tap (which is the insertion of a needle in between two (2) bones in the spine where fluid that surrounds the brain and spinal which is meant to protect them from injury). This procedure is the method used to diagnose the disease. This method of diagnosis is also used to check for disorders that affect the central nervous system such as multiple sclerosis, certain cancers of the brain and spinal cord are also diagnosed using this method.

Once diagnosed, treatment using the appropriate antibiotics must be started and lack of confirmation of diagnosis should not delay treatment. Antibiotics such as penicillin, ampicillin, chloramphenicol and ceftriaxone can be used to treat the infection, however, ceftriaxone is the drug of choice for CSM in Africa.

To prevent and control the spread of  CSM, there is the need to be vaccinated or immunized against it. Vaccines have been around for more than forty (40) years with the vaccine being improved over time, however, there is no universal vaccine against meningococcal disease and this is because the disease exists in strains the vaccines are strain specific and have varied degrees of protection for certain durations  and there are three (3) types of vaccines.

• Polysaccharide vaccines are used during a response to outbreaks, mainly in Africa, these are not effective before two (2) years of age and offer a three (3) year protection period.
• Conjugate vaccines are used in prevention (into routine immunization schedules and preventive campaigns) and outbreak response. These provide a five (5) year or longer immunity period. It also provides a preventative measure against carrying the disease and can be used on kids from the age of one (1).
• Protein based vaccine which has been introduced into the routine immunization schedule and used in outbreak response.