The infection that could be more deadly for students than coronavirus

Waking up with a pounding head and feeling sick, student Ben de Souza put his symptoms down to a hangover and decided the only thing to do was stay in bed.

Just eight weeks into his first year at the University of Portsmouth last year, Ben had been living student life to the full. The night before, he’d been clubbing with friends from the university cricket club.

But as the day progressed, he threw up ten times and became increasingly drowsy. 

‘I just couldn’t stop being sick and my head felt like it was going to explode,’ says Ben. 

‘I thought I’d drunk too much or had flu, so decided to stay in my room.’

It was a mistake that almost cost Ben his life: 12 hours later, on November 30, 2019, he was rushed to intensive care, where he spent five days battling for survival.

The 19-year-old business student from Burgess Hill, West Sussex, had in fact contracted a particularly aggressive form of meningitis B, a strain responsible for most cases of bacterial meningitis.

Caused by the meningococcal group B bacteria, the infection can cause not just meningitis — infection of the membranes surrounding the brain and spinal cord — but meningococcal sepsis, an over-reaction of the immune system which can lead to tissue damage, organ failure and death.

Although Ben survived, it almost robbed him of his ability to walk. He needed ten months of intensive physiotherapy and has had to take close to a year off from his studies to recover.

This week, as thousands of students return to university for the first time since lockdown, doctors and charities are warning that they may confuse the symptoms of meningitis for Covid and self-isolate, rather than seeking urgent medical help.

‘Meningitis acts fast and can kill within hours,’ warns Simon Kroll, a professor of paediatrics and molecular infectious diseases at Imperial College, London, and medical director at the charity Meningitis Now. ‘Early intervention will typically improve outcomes.

‘While self-isolation is right for Covid-19, to lock yourself away from others if there is a suspicion it could be something like MenB could be disastrous.

‘It is important that young people, particularly those moving to university, are aware of this and that they don’t assume that any flu-like illness is Covid-19.’

According to Public Health England, there were 305 reported cases of MenB in England alone last year, and the infection proved fatal in a tenth of cases.

The bacteria is spread through kissing, coughing and sneezing, and although most common in babies and young children, a fifth of cases occur in teenagers and those under 25.

Students are particularly vulnerable not only because they live in such close proximity to each other, but also because up to a quarter of people aged between 15 and 24 carry the meningococcal bacteria in the back of their throats compared to one in ten of the general population.

Another problem is that in some cases, MenB doesn’t always present with symptoms often associated with meningitis such as a rash and a stiff neck, and can sometimes feel like a hangover or flu.

Professor Kroll says symptoms include drowsiness, vomiting, cold hands and feet, fever, confusion, muscle pain and headaches.

‘You may see pale, blotchy skin or a rash, but do not wait for this to show. It may not appear — and if it does it could indicate that sepsis is taking hold.’

In 2015, after a five-fold increase in cases of a different type of meningitis, MenW, the government started to vaccinate teenagers from Year 9 upwards with the ACWY jab, which protects against meningitis strains A, C, Y and W. 

The vaccine is available free for anyone up to the age of 25, and figures reveal that 80 per cent of young people are now inoculated. However, they may not realise that they’re not protected against viral meningitis or certain strains of bacterial meningitis, such as B. 

Like many other people his age, Ben had received the ACWY jab at school but was not protected against MenB. There is a vaccine against MenB but the NHS only gives it to babies, although it is available privately. It means many young people — and their parents — may be unaware of the risks they face.

‘Meningitis and sepsis often happen together, and both can kill within hours and leave those who survive with life-changing effects,’ warns Professor Kroll.

Ben survived, he says, only because of the vigilance of his five flatmates who heard him throwing up and kept checking on him. ‘They banged on my door that afternoon to see how I was, and I remember asking them to get me some Lucozade and paracetamol,’ he recalls. After that, he has a hazy recollection of one of them trying to give him some water.

Unbeknown to him, his flatmates continued to check on him throughout the night, and when one of them found Ben collapsed on his floor at 5am, she immediately called an ambulance.

By the time the paramedics arrived, Ben couldn’t even tell them his name. Shortly after he arrived at Queen Alexandra Hospital in Portsmouth, he became unconscious and had to be put on a ventilator.

Within the next few hours, his parents, twin brother Alex and three older sisters arrived at the intensive care unit. 

‘We were told that Ben was the sickest patient in the entire hospital, and it was obvious to me that he might not make the night,’ says his mother Arlene, 56, a former paediatric nurse.

‘Even with a medical background, nothing could have prepared me for the shock of seeing my son so deeply unconscious and so desperately ill.’

Those next few hours were a rollercoaster: Ben had seriously damaged his right lung by swallowing his own vomit shortly after arriving in hospital.

And although there was no sepsis, the meningitis was causing his brain to swell and it was starting to push down on his spinal cord — a process called coning, which usually occurs shortly before death.

Desperate, medics pumped his body with saline to relieve pressure on the brain, an intervention that undoubtedly saved his life.

But an MRI scan later that day revealed that the stress on his body had caused him to have two strokes in the area that controls movement and breathing.

Doctors were unsure if he would survive but, remarkably, he slowly regained consciousness over the following days.

‘We were told by his medical team that if he’d arrived at the hospital just ten minutes later, he wouldn’t have survived, and I’ll never be able to thank his flatmates enough for saving his life,’ says Arlene, who, along with Ben, is now working with Meningitis Now to raise awareness of the potentially lethal illness.

Ben is returning to university to restart his course this week, marking the end of a relentlessly challenging time. After six-and-a-half weeks in the intensive care unit, he spent a further six-and-a- half weeks at the hospital’s rehabilitation unit as he learned to walk again.

The two strokes he had after going into intensive care severely affected his mobility, and there was a risk that he’d end up in a wheelchair. Happily, by the time he left hospital in February, he was fully mobile again.

‘It’s been hard but I know I’ve been lucky,’ says Ben, who hopes to become a naval officer when he leaves university.

‘Last week, I saw my neurologist who told me my recovery has been quite miraculous, and I know not everyone is as fortunate.’

Indeed, according to studies by the Meningitis Research Foundation, one in five meningitis survivors across the world is left with permanent effects such as the loss of a limb, brain injury, memory problems or a visual or hearing impairment.

With the world focused on the pandemic, it is easy to forget that there are other serious illnesses out there, says Dr Tom Nutt, CEO of Meningitis Now.

‘Our message to parents as they battle with the uncertainties of university living arrangements and online tutorials is to be certain that their children are aware of the signs of meningitis.

‘If they’re feeling unwell, they shouldn’t assume it’s Covid-19 or a hangover. If they’re unsure, they need to call NHS 111 right away.’

Ben couldn’t agree more. ‘I wish I’d realised how ill I was and got help sooner,’ he says. 

‘I’d say to anyone, whatever age you are, that if you start to feel really unwell, don’t shut yourself away. If in doubt, shout!’

meningitisnow.org

Alternative medicine

Pharmacist Gemma Fromage reveals the unexpected uses for every day products. This week: Turmeric for arthritis.

Turmeric — the yellow spice in curry — has a number of health benefits. Research has shown that curcumin, a compound in turmeric, has not only antioxidant properties that protect cells from damage but also anti-inflammatory benefits thought to help arthritis.

When patients with moderate knee osteoarthritis were given capsules containing curcumin daily for six weeks, they experienced improvements in pain and physical function, reported the journal Phytotherapy Research in 2014.

A second study in the same journal compared three groups, one taking curcumin, the second an anti-inflammatory (diclofenac sodium), and the third, a combination of both.

All three groups saw improvement in disease activity scores, but the curcumin-only group showed the most improvement.

If you’re considering turmeric supplements, talk to your doctor and do not stop regular medication without medical advice.