🧠 Men's Health

Meningitis in Nigeria — Causes, Symptoms & Prevention

Q: Is meningitis always bacterial?

No — meningitis can be bacterial, viral (most common overall — usually milder and self-limiting), fungal (Cryptococcus in HIV patients), tuberculous (TB meningitis — chronic, serious), or caused by parasites. Bacterial meningitis is the most life-threatening and requires emergency treatment. Viral meningitis usually resolves without specific treatment but is very uncomfortable.

Q: What is the 'glass test' for the meningitis rash?

Press a glass firmly against the skin where a small red/purple rash has appeared. If the rash DISAPPEARS (blanches) under pressure = it is likely from blood vessels dilating (non-specific) and is less worrying. If the rash DOES NOT DISAPPEAR (non-blanching) = petechiae or purpura from bleeding under the skin — this is a medical emergency and suggests meningococcal septicaemia. Call for emergency help immediately.

Q: Can meningitis be prevented with a vaccine?

Yes — meningococcal ACWY conjugate vaccine provides strong protection against the most common strains causing epidemic meningitis in Nigeria. It is available at government immunisation centres, especially in northern states. It is mandatory for Hajj. Pneumococcal vaccine (PCV13, given to infants in the National EPI) protects against the second most common bacterial cause. Hib vaccine (also in EPI) protects against Haemophilus influenzae meningitis in children.

Q: My child survived meningitis — what long-term effects should I watch for?

Hearing loss is the most common complication — 20–30% of survivors have significant sensorineural hearing loss. Early audiological assessment (within 4–6 weeks of recovery) is essential. Other complications: cognitive difficulties, learning disability, epilepsy, hydrocephalus, limb loss (from meningococcal septicaemia causing gangrene). Rehabilitation planning should begin early. Hearing aids or cochlear implants can significantly help hearing-impaired survivors.

Understanding bacterial meningitis in Nigeria — a life-threatening emergency

Meningitis is inflammation of the meninges — the three membranes covering the brain and spinal cord — usually caused by infection. Nigeria lies within the 'meningitis belt' of sub-Saharan Africa stretching from Senegal to Ethiopia, where epidemic meningococcal meningitis (Neisseria meningitidis) outbreaks recur regularly — particularly in the dry season (December–June) in northern Nigeria. Major outbreaks occur every 5–10 years in Nigeria; Zamfara, Kebbi, Sokoto, Niger, Katsina, Kano, and Jigawa states are most frequently affected. Bacterial meningitis is a medical emergency with a case fatality rate of 10–30% even with treatment, and 10–20% of survivors have permanent disability (hearing loss, brain damage).

Signs and Symptoms

✓ Classic triad: fever + severe headache + neck stiffness (meningism)

✓ Photophobia: severe sensitivity to light

✓ Phonophobia: sensitivity to sound

✓ Nausea and vomiting

✓ Altered consciousness: confusion, drowsiness, or coma

✓ Seizures

✓ Non-blanching petechial or purpuric rash: small red/purple spots or larger bruising that do NOT fade when pressed with a glass — specific to meningococcal septicaemia. EMERGENCY

✓ Infants: bulging fontanelle, high-pitched cry, refusing feeds, not waking normally — the classic triad is often absent in infants

Risk Factors

Northern Nigeria: living in or travelling to the meningitis belt
Dry season and Harmattan (November–April): dry air disrupts nasopharyngeal mucosa, allowing meningococcal colonisation
Close contact settings: boarding schools, military barracks, refugee camps, hajj gatherings
Children under 5 and young adults (15–29): highest attack rates
Unvaccinated individuals: meningococcal vaccine provides significant protection
HIV and immunosuppression: cryptococcal meningitis (Cryptococcus neoformans) is the most common meningitis in HIV patients with CD4 < 100
Skull fractures or CSF leaks: recurrent pneumococcal meningitis

When to Seek Help

EMERGENCY — any of these signs: go to hospital immediatelyFever + severe headache + neck stiffness. Non-blanching rash in a febrile person. Fever + altered consciousness. Infant with bulging fontanelle and fever. Do not wait — every minute of delayed treatment increases mortality and disability

During a meningitis outbreak in your stateAny severe febrile illness with headache should be assessed immediately — case fatality is reduced by prompt treatment

After confirmed meningococcal contact (within 7 days)Close contacts of meningococcal meningitis cases should receive prophylactic ciprofloxacin or rifampicin — contact your State Epidemiologist

Hearing loss after meningitis20–30% of bacterial meningitis survivors develop sensorineural hearing loss — audiological assessment and hearing aids if needed

Tests & Diagnosis

🧪 Lumbar puncture (LP) and cerebrospinal fluid (CSF) analysis

The definitive diagnostic test — position patient, insert needle into lumbar spine, collect CSF. Appearance, cell count, protein, glucose, gram stain, culture and sensitivity. In bacterial meningitis: cloudy CSF, high white cells (neutrophils), high protein, low glucose

🧪 Blood cultures

Taken before antibiotics — identifies causative organism and antibiotic sensitivity in 50–75% of cases

🧪 CT brain before LP

Only if focal neurological signs, papilloedema, or altered consciousness — rule out raised intracranial pressure before LP to prevent herniation

🧪 Rapid antigen tests (CSF or urine)

Detect meningococcal, pneumococcal antigens quickly when gram stain is negative. Available at some Nigerian centres

🧪 PCR of CSF

Highly sensitive when culture is negative (as happens when antibiotics already started) — available at NCDC reference laboratory

🧪 FBC, CRP, procalcitonin

Leucocytosis + very high CRP/procalcitonin = bacterial meningitis. Lymphocytosis = viral or TB meningitis

Treatment Options

Antibiotics — start immediately, even before LP if LP will be delayed

Adults: ceftriaxone 2g IV twice daily + dexamethasone 0.15mg/kg IV 4-hourly for 4 days. Children: ceftriaxone 100mg/kg/day IV. If penicillin allergy: chloramphenicol. Dexamethasone significantly reduces mortality, deafness, and neurological sequelae — give first dose before or with first antibiotic dose

Dexamethasone

Critical adjunctive treatment — reduces brain inflammation and hearing loss risk. 0.15mg/kg IV every 6 hours for 4 days. START IMMEDIATELY with first antibiotic dose

Supportive care

Airway management, IV fluids for septic shock, seizure control (diazepam, phenobarbitone), antipyretics

Cryptococcal meningitis (HIV patients)

Amphotericin B 0.7–1mg/kg/day IV for 14 days + flucytosine 25mg/kg QID for 14 days, then fluconazole 400mg daily for 8 weeks, then 200mg daily maintenance. Lumbar punctures to manage raised intracranial pressure are often needed

TB meningitis

RHEZ regimen + dexamethasone for 4 weeks — diagnosis is difficult (lymphocytic CSF, high protein, low glucose, very slow culture). Treat empirically in appropriate clinical context

Prevention: meningococcal vaccination

MenACWY conjugate vaccine — single dose. Recommended for all individuals in northern states and for all Hajj pilgrims (mandatory requirement). Mass vaccination campaigns during outbreaks conducted by NCDC/WHO. Available at government immunisation centres

Frequently Asked Questions

Is meningitis always bacterial?

No — meningitis can be bacterial, viral (most common overall — usually milder and self-limiting), fungal (Cryptococcus in HIV patients), tuberculous (TB meningitis — chronic, serious), or caused by parasites. Bacterial meningitis is the most life-threatening and requires emergency treatment. Viral meningitis usually resolves without specific treatment but is very uncomfortable.

What is the 'glass test' for the meningitis rash?