Introduction:

Meningococcal meningitis is a bacterial disease caused by Neisseria meningitidis . Of the 13

subtypes or serogroups of Neisseria meningitis identified, as A, B, C and W are recognized to be
the main causes of epidemics, while endemic disease and occasional outbreaks are also caused
by bacteria belonging to other serogroups, including Neisseria meningitis Y and X. The
pathogenicity, and epidemic capabilities differ according to the serogroup. Bacterial meningitis
is an inflammation of the leptomeninges, usually causing bacterial infection. It may present
acutely symptoms evolving rapidly over 1-24 hrs; sub-acutely symptoms evolving over 1-7 days
or chronically symptoms evolving over more than one week.
Meningitis outbreaks are detected through the enhanced meningitis surveillance network,
whereby countries collect and send countrywide weekly district level data to the WHO West
African Inter-Country support team, which then compiles and analyses the reports, and
disseminates the data in a weekly bulletin. In 2015, the 19 participating countries reported an
increase in the number of cases and epidemic districts, compared to 2013 and 2014. During the
2015 epidemic season, they reported a total of 21 649 suspected meningitis cases including
1577 deaths. Among the reporting countries, the epidemic threshold was crossed in 26 districts.
The epidemic activity was comparable to that of 2012 when a Neisseria meningitis epidemic
affected several West African countries. Also in 2015, Neisseria meningitis caused large-scale
outbreaks in Nigeria and Niger. The population of all 4 Niamey districts was severely affected by
the epidemic, with 64% of the total reported number of cases. Weekly attack rates in the most
affected district in Niamey peaked at 220 cases per 100,000 population, while the cumulative
attack rate reached 992 cases per 100000 population. Reactive mass vaccination campaigns
remain an important pillar of meningitis outbreak response. Emergency global vaccine
stockpiles are managed by the International Coordinating Group on Vaccine Provision for
Epidemic Meningitis Control (ICG). In 2015, mass vaccination campaigns were organized in
response to the epidemics in Nigeria and Niger. The ICG released 357 250 doses of
polysaccharide ACYW vaccine to Nigeria and vaccination campaigns were conducted in 11 LGAs
in Kebbi state and in 6 LGAs of Sokoto State.
WHO, with the assistance of partners in the Global Outbreak Alert and Response Network, is
supporting the Department of Health, Philippines in strengthening epidemiological surveillance,
increasing laboratory capacity for detection/confirmation of meningococcal disease, and
implementing additional epidemiological studies. From 1 October 2004 to 16 January 2005, a
total of 38 cases of meningococcal disease and 18 deaths has been reported from Baguio City
and a total of 40 cases and 12 deaths reported from the Cordillera Region, excluding Baguio
City. Out of the total of 78 cases, 11 have been laboratory confirmed for N. meningitidis by the
Baguio General Hospital and the Research Institute for Tropical Medicine. Since 7 January the
number of weekly cases has decreased. Current control measures include case management of
suspect cases, active surveillance and chemoprophylaxis of close contacts as well as vaccination
of health workers directly involved in case management.
Patient Profile

- Patient P.W is a 60 years old, Roman Catholic, Filipino, single, female. Born on June 29,
1959 in the Metro Manila area. The patient can speak Filipino. She is a high school
graduate, has worked as a seamstress for the last 19 years and resides in Cagayan with
her daughter and her sister.

At 7:45pm on Friday December 6, 2019 the patient was admitted via the out-patient
department at the University Of The East Ramon Magsaysay (UERM) for a direct
admission at the Neurology ward for a scheduled lumbar tap procedure.
Chief Complaint

- Lower back pain of few months duration

Admitting Diagnosis

- Bacterial Meningitis T/C Epidural Abscess

Present Health History

- Six months prior to admission, the patient was reportedly seen unconscious by her sister
and noted vomiting of previously ingested food. These symptoms prompted the patient
to go to their local hospital wherein laboratories were done and there were unrecalled
medications given. The patient was seemingly well and there were no recurrences of
these symptoms until September 2019.

Twelve weeks prior to admission, the patient started to notice intermittent back pain in
which the patient described as sharp, colicky pain which was temporarily relieved by
massaging. There were no associated symptoms and the patient sought consult wherein
she was treated as a case of UTI and arthritis. The patient was sent home with
unrecalled medications. In the interim, the back pain persisted but at a tolerable level
that is aggravated by flexing the neck, brisk walking and movement.

One month prior to admission, the patient had a bone scan and MRI during her annual
check-up at Cardinal Santos hospital wherein the result prompted a referral to our
institution for a lumbar tap procedure.

One week prior to admission, the patient was admitted to our institution for a lumbar
tap. The patient tolerated the procedure well and was sent home and advised to follow-
up once with result.
Past health history

- Patient is a 60 years old female, known case of breast cancer stage II year 2011 status
post modified radical mastectomy year 2011 status post six cycles chemotherapy from
Cagayan. No accidents, allergies or chronic diseases such as asthma or diabetes.
Childhood immunizations are reported to be complete but unrecalled. No illnesses
occurred in childhood.

Family history

- Both P.W’s parents have known hypertension, P.W has 3 other siblings, her being the
second of the 4. The third sibling has had a known case of appendicitis. All other siblings
are alive and well.

Psychosocial history

- The patient is a 60 year old female, single, and mother of 3 (two females and one male)
and is the second older child in her family. All siblings are currently alive and still in
contact with one another. The patient lives in a home with her one younger daughter.
Two of her children live out of the home because they both have families of their own.
Patient P.W has been a smoker for 2 years (started in 2000) and recently decided to quit
because she is aware that it will cause harm to her health. The reason she started
smoking was because she was curious about trying it and when she tried it, she enjoyed
it. She also drinks alcoholic beverages occasionally. She reports no use of illicit drugs and
no history of mental health illnesses or symptoms of depression and anxiety.

Developemental History:

- Patient P.W works as a seamstress at Cagayan City. She stated that for her, her season is
to work and provide for herself and also to help her children in finances. In line with the
patient’s activities and plans, according to Erick Ericson’s developmental stages, a
person ages 40s, they enter the time known as middle adulthood, which extends to the
mid-60s. The social task of middle adulthood is generativity vs. stagnation. Generativity
involves finding your life’s work and contributing to the development of others through
activities like raising children. They develop the sense of wanting to establish a firm,
happy and strong commitment willing to make sacrifices and compromises that a
relationship requires. During this stage, middle-aged adults begin contributing to the
next generation, often through childbirth and caring for others; they also engage in
meaningful and productive work which contributes positively to society. Those who do
not master this task may experience stagnation and feel as though they are not leaving a
mark on the world in a meaningful way; they may have little connection with others and
little interest in productivity and self-improvement.
Concept map