With the weather getting warmer, meningitis cases have started trickling in. So have people with the ubiquitous flu. The initial symptoms of both diseases are so similar that not just patients but doctors too are confusing one for the other.
The textbook signs of meningitis include high fever and headache accompanied with a red rash combined with a stiff neck, sensitivity to light and impaired consciousness. Some people may also report symptoms of muscle aches and weakness, tingling or weakness all over the body, as well as dizziness.
The trouble is that these develop in the later stage of illness. “These symptoms usually can take up to 24 hours to appear, which causes crucial delay in treatment. In several cases, the symptoms do not appear at all,” says Dr Panna Chaudhury, senior paediatrician at Lok Nayak Hospital. The classic meningitis symptoms of rash have been altogether absent from among the cases reported this year.
Clinicians are now asking people to also look out for fever accompanied by leg pain, cold hands and feet and an abnormally pale or mottled skin colour, which can develop within eight hours. This could give doctors a few crucial hours in which to diagnose and treat the infection and save lives. “In this situation, you should visit a doctor if you develop high fever and severe persistent headache,” says Dr Anoop Misra, director, Fortis Hospital.
The misdiagnosis is not unique to India. Last year, Oxford University investigated 448 children who contracted meningococcal meningitis, the most dangerous bacterial form of meningitis (viral meningitis also occurs). Most had only mild symptoms in the first four to six hours, but were close to death 24 hours after infection, they reported in the journal, The Lancet. The study found that classic symptoms developed late, after an average 13 to 22 hours.
Chaudhury, who has been getting one to two meningitis patients each day, says the first question he asks patients with symptoms of fever is whether they are feeling active. “Meningitis causes sluggishness, drowsiness and fatigue to such an extent that the person may appear comatose. Observing whether the child is active when the fever is down is an indication that it is not meningitis,” says Chaudhury.
Symptoms of bacterial meningitis usually develop suddenly, while those of viral meningitis may develop suddenly or gradually over a period of days. For example, the symptoms of viral meningitis after mumps may take several days or weeks to develop.
The good news is that all the patients are responding well to treatment. “Injecting Ceftriaxone, which belongs to a group of antibiotics called cephalosporins, twice a day for a week to 10 days helps the patient recover quickly,” says Dr Misra.
The vaccine against meningitis is readily available, but does not offer immediate protection. It takes about two weeks to develop immunity against the disease. “There is no need for mass vaccination at this stage. Unless you are in close contact to the patient, taking an antibiotic such as ciprofloxacin as a precaution is enough,” says Dr Ashok Jhingan, senior consultant of medicine at Jaipur Golden Hospital.
Misra advises more caution. “There is no outbreak yet but since meningitis cases go up in February, those at risk — babies, young children and the elderly — should consider vaccination,” says Misra.