Bre Payton’s illness(es).

On December 28, 2018, 26 year old political journalist, Bre Payton, died of what appears to be two completely different infections – H1N1 influenza (aka flu) and meningitis.

  • There are many unanswered questions at this time.
    • Did she get the Flu vaccine this flu season?
      • Flu vaccines only reduce risk of flu by 40 – 60%.
        • This means, we need basic infection prevention AND the Flu vaccine.
          • Click HERE for tips on flu prevention.
  • Meningitis can be caused by bacteria as well as viruses.
    • Viral meningitis usually resolves without treatment.
    • Bacterial meningitis is more severe, needing specific diagnosis and prompt treatment with appropriate antibiotics.
      • Streptococcus pneumoniae (aka pneumococci)
        • and Neisseria meningitidis (aka meningococci) are
          • the usual bacterial suspects in young adults like Bre Payton.
            • young adults are 18 – 35 years old
      • There are other bacteria that can cause meningitis too – a topic for later discussion.
      • I will discuss meningococcal meningitis first, because it can progress much more rapidly and death can occur within just hours of onset of symptoms!

Diagnosis of meningococcal meningitis can be a bit tricky.

  • Typical symptoms only appear later in the illness.
    • By this time, it may either be too late to save the patient, as perhaps in the case of Bre Payton, or too late to avoid severe neurologic defects in survivors.
  • Initial symptoms may include:
    • sudden onset of fever, nausea, vomiting, headache, decreased ability to focus and concentrate, and muscle aches in an otherwise healthy patient
      • the pain may even be very intense
  • Most, if not all of these symptoms may also be seen in someone with flu.
    • Bre Payton seems to have had flu as well, which would have obscured the urgency of her symptoms for a meningitis diagnosis.

You need a high degree of suspicion to even suspect meningococcal meningitis. The healthcare provider also needs to look carefully for certain clinical signs.

  • The patient should be fully undressed before looking for tell tale symptoms such as:
    • tiny, hemorrhagic spots aka petechiae
      • The first place to show these petechiae are places where belts, elastic straps etc. apply some pressure on the skin
      • Petechiae can worsen into
        • larger, purpuric (purplish) areas and
        • larger bruises caused by ruptured blood vessels leaking blood into tissue

Pneumococci cause more than ½ of the bacterial meningitis cases in the United States. 

  • Signs & symptoms are not always specific:
    • severe and generalized headache
  • There is at least 1 of the following:
    • fever
      • mostly high, but sometimes lower than normal
    • stiffness of the neck
    • altered mental state…
      • resulting in patient being confused or lethargic

TWO VACCINES offer PROTECTION:

  • Pneumovax 23®
    • for ages 65 years and up
  • Prevnar 13®
    • for ages 18 years and up
    • for babies at 2, 4, 6, and 12 – 15 months

How does a person “catch” meningitis?

  • Some people carry meningococci and pneumococci in their nasopharynx, without being sick from them.
    • These people are called carriers.
      • nasopharynx
        • upper part of the throat, behind the nose, and above the soft part of the roof of the mouth
  • Carriers or sick people spread bacteria during
    • coughing, sneezing and kissing
    • These bacteria are not spread by casual contact.
  • In addition, people are at risk of meningococci if they live in the same household, college dorm, military unit (or similar confined spaces) as carriers or people who are sick with meningitis.

What is essential for prevention (in addition to the vaccines)?

  • BASIC INFECTION PREVENTION
    • Hand hygiene
      • use soap and water, if available, OR
      • alcohol based hand sanitizer (60 – 95% alcohol)
    • Good cough and sneeze etiquette
    • Staying home when sick (to minimize spreading the infection).
      • Basically, the same basic tips we have talked about for prevention of flu, will work here too!

Bre Payton’s death is a tremendous loss for all of us. In my opinion, the best protection for our young people and for all of us really, is specific immunologic protection (elicited by vaccines when available) together with basic infection prevention

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