Edwin’s symptoms of high fever, a stiff neck, and severe headaches indicate that he suffers from meningitis. Although Edwin does not report any other sick students that live with him, meningitis is not as contagious as the flu (Centers for Disease Control and Prevention [CDC], 2011), so it is possible that there will be no outbreak among the residents in his fraternity house. While meningitis is associated with high leukocyte counts, that piece of information is not relevant for distinguishing the type of meningitis. Further diagnostic tests are required to identify other factors that will allow a clear distinction between viral and bacterial meningitis. With the current amount of reported symptoms and lab results, Edwin could suffer from either bacterial or viral meningitis.
Meningitis is caused by viruses or bacteria, so it can be classified as viral meningitis and bacterial meningitis. The most common contemporary causes of bacterial meningitis are Streptococcus pneumoniae and Neisseria meningitidis; the most common contemporary causes of viral meningitis are enteroviruses (CDC, 2011). Although cases of viral infections outnumber the cases of bacterial infections, it is not possible to rule out any organisms before performing tests on the patient’s spinal fluid (CDC, 2011). However, without any specific evidence, I believe that the infection in Edwin’s case is bacterial. It is possible that either S. pneumoniae or N. meningitidis are responsible for the infection, but I believe S. pneumoniae can be considered the cause of Edwin’s meningitis.
S. pneumoniae accounts for 61 percent cases of bacterial meningitis in the United States, so it is considered the most common etiological agent for bacterial meningitis (Brouwer, Tunkel, & van de Beek, 2010). Although some attempts have been made to develop a vaccine against pneumococcal meningitis, only 50 percent success rates have been recorded in clinical studies (Brouwer et al., 2010). It consists of a closed, circular DNA that has approximately 2.05 million base pairs, and 154 of its genes contribute to virulence. The S. pneumoniae has several virulence factors that can manifest during infections. One example is autolysin, a protein used by the bacteria to release its internal contents. In meningitis cases, S. pneumoniae uses hydrogen peroxide to compete with other bacteria and cause damage to the host. S. pneumoniae is common in healthy adults, but it sometimes acts as an opportunistic pathogen when the immune system is compromised. That is why I consider that Edwin’s previous cold could have encouraged the development of a pneumococcal pneumonia.
N. meningitidis is a bacterium responsible for many mortality cases of meningitis during childhood, and it was responsible for several epidemics that occurred in Africa, Asia, and America. For example, in 2008, 53 percent cases of meningitis in the United States were caused by N. meningitidis (Brouwer et al., 2010). N. meningitidis does not affect animals because it can obtain iron only from human sources. While it exists as a nonpathogenic agent in many adults, it can cause major epidemics once it activates. It contains Lipooligosaccharide on its outer membrane that it uses as an endotoxin to destroy red blood cells. Its polysaccharide capsule is another virulence factor that prevents immune response detections. Because N. meningitidis is usually accountable for epidemics, I believe Edwin was infected by S. pneumoniae rather than N. meningitidis.
The main symptoms that contributed to my decision were Edwin’s complaints about high fever, stiff neck, and severe headaches. Meningitis also affects the state of mind and clarity, so Edwin’s cloudy thoughts are probably the result of the infection. Clinical research indicates that those are the most common symptoms in people with bacterial meningitis (Brouwer et al., 2010). Another possible diagnosis was the influenza, but that was ruled out because a stiff neck is not a common symptom for people who have the flu. A stiff neck is a symptom specific to meningitis while influenza often causes pain in all joints. Furthermore, influenza infects the respiratory system, and the patient did not report any respiratory issues. Finally, Haemophilus influenzae is a common cause of bacterial meningitis, but the chances for that particular organism to infect a person are low because immunization against it has been obligatory since the 1990s (CDC, 2011), so I did not consider it as a relevant factor in this case.
However, the lab results provided only stated that the count of white blood cells was higher than regular. A high amount of blood cells can only identify the presence of a pathogen, but it cannot specifically define which pathogen is responsible for the infection. According to Ihekwaba, Kudesia, and McKendrick (2008), it is difficult to establish the difference between viral and bacterial meningitis, so the first choice is usually to begin antibiotic treatments because bacterial infections are more hazardous than viral infections. That is why I initially assumed that it was a bacterial infection. After correlating Edwin’s symptoms with the microorganisms that could have caused them, I concluded that S. pneumoniae is responsible for the infection.
Meningitis is a contagious disease. It can be transferred through the air, fluids, stool, or infected surfaces. The transfer method depends on the underlying cause of meningitis. Bacterial meningitis can be contagious when the bacteria spread through respiratory exchange or through secretions (CDC, 2011). However, casual contact with patients or breathing the air in close contact with the patient does not contribute to spreading the disease (CDC, 2011). On the other hand, viral meningitis is usually transferred through fecal contamination and respiratory secretions (CDC, 2011). The common transfers for both types of meningitis are bodily fluids and secretions. In Edwin’s case, the S. pneumoniae probably activated as the result of a recently weakened immune system.
Viral meningitis is easier to cure than bacterial meningitis because it does not have severe consequences. Even when patients do not engage in any particular treatment, viral meningitis tends to pass and does not cause permanent damages (CDC, 2011). Viral meningitis treatments are usually effective, but the choice of antiviral medication depends on the type of virus responsible for the infection (CDC, 2011). Antibiotics do not kill viruses, and that is why meningitis can be cured only after obtaining a proper diagnosis. Unlike viral infections, bacterial meningitis requires immediate treatment because they can lead to further permanent complications.
If the correct microorganism is identified at the beginning of the treatment, the chances of a fatal outcome are reduced below 15 percent (CDC, 2011). If bacterial meningitis is not treated immediately, the patient may develop several complications. Sepsis, low blood pressure, tachycardia, blood coagulation, hemorrhage in the adrenal glands, seizures, and herniation are some common complications of bacterial meningitis. Overall, bacterial meningitis infections are life-threatening because their intensity and complications are associated with severe disability and high morbidity rates (Tebruegge & Curtis, 2008). Because of recent improvements in antimicrobial therapy, the mortality rates have decreased, and major health centers report morbidity rates between 20 and 25 percent (Tebruegge & Curtis, 2008). When bacterial meningitis treatments fail because of poor adherence or incorrect treatment choices, patients can suffer from recurrent meningitis.
Brouwer, M. C., Tunkel, A. R., & van de Beek, D. (2010). Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clinical Microbiology Review, 23(3), 467-492. doi:10.1128/CMR.00070-09
Centers for Disease Control and Prevention. (2011, March 11). Meningitis: Questions and answers. Retrieved from http://www.cdc.gov/meningitis/about/faq.html
Ihekwaba, U. K., Kudesia, G., & McKendrick, M. W. (2008). Clinical features of viral meningitis in adults: Significant differences in cerebrospinal fluid findings among herpes simplex virus, varicella zoster virus, and enterovirus infections. Clinical Infectious Diseases, 47(6), 783-789. doi:10.1086/591129
