By Tayo Fasuan
A young boy once had a wound that was allowed to fester. However, by the time the parent decided to finally tend to that wound, something else had happened. The boy was having symptoms of meningitis, and after the test was carried out, an extremely painful test called cerebro-spinal fluid test (CSFT), the boy was diagnosed with meningo-encephalitis. It took a combination of treatments from many consultants within that medical center to save his life eventually.
This short story is a real-life story encountered by the writer when still in training. At that time, it made no meaning to me. But as years pass by, the importance of that incident became more evident. In an article written by this writer, trying to clarify between self-medication and self-treatment, caution was advised about self-medication, and emphasis was laid on the importance of quick diagnosis and treatment of infection.
Many microbes cause various types of infections. Like a colleague once said, microorganisms are the scourge of humans because of their versatility and ubiquitous-ness. They are simply everywhere! Initially, human thought they were fortunate because all these microbes seem incapable of infecting everything within our body. Even up till now, microorganisms are still largely tissue/cell specific, infecting only tissues and organs that have unique characteristics and specifications required by the infecting microbes. For bacterial infections, these requirements include the pH, the nutritional quality, moisture content and presence of other competing microbes. For viral infection, the major requirement is the receptors present on the surfaces of susceptible cells, which should be complementary to the ligand on the virus.
Hence, microbes like Helicobacter pylori can only attack the walls of the gut, while Candida albican can infect epithelial lining of the mouth and vagina. Enteroviruses and rotaviruses will only infect cells of the gastrointestinal tract; Staphylococcus epidimidis will prefer the skin; Rabies virus has preference for the nerve cells. There are some organisms, however, which can infect a wide range of tissues provided the environmental conditions are suitable. Prominent among these are Escherichia coli and Staphylococcus aureus for the bacterial population and perhaps, based on recent researches, measles and West Nile viruses for the viral population.
Tissue specificity has always make diagnoses of infections easy: if it is this organism, that will be the organ or tissue infected. However, experience, accumulated knowledge and researches have pointed out th that this is usually not usually the case; more so if the infection being under discussion has been allowed to disseminate and spread.
Dissemination of infectious, causative microbes is always aided by the blood. Once an organism infects a cell, it proliferates and multiplies, and if not controlled quickly enough, the resultant population spread to infect the neighbouring cells and tissues. This is disseminated infection, and it is usually termed bacteremia (for bacterial infections) and viremia (for viral infections). The medium of transportation to these new sites of infection is, of course, blood. This is why bacteremia or viremia is usually defined clinically, as the respective presence of bacteria or viruses in the blood.
Once disseminated, the infectious agent can potentially reach anywhere within the body as far as the blood can go. This provides a platform for that invading microbe to attack any cell, tissue and organ it can. Disseminated infections are quite serious and complicated, because diagnoses are usually difficult, long, expensive and sometimes extremely uncomfortable, invasive and painful. The same thing goes for the treatments which in most cases are even risky to the life of the patient. A straightforward case of Escherichia coli-induced gastroenteritis in the gut will definitely become complicated when the infection disseminated to the colon, while an untreated case of mild upper respiratory tract infection would become dangerous when it spread to the lower respiratory tract and a disseminated skin infection due to Staphylococcus aureus can lead to urinary tract infection (UTI).. Viruses such as West Nile virus (WNV) has garnered much importance over the years due to its ability to quickly metamorphose from a mild fever infection which would have resolved by itself to severe illnesses like meningo-encephalitis, acute flaccid paralysis and recently, hepatitis.
While it is not possible for the microbe to attack some tissues which do not have the enabling environment for infection, most resultant diseased conditions is usually as a result of the actions of the immune system, which in most cases would result into inflammation. This is why a disseminated yellow fever infection can lead to myocarditis. The inability of the blood to cross the blood-brain barrier can eventually result into subsequent infection and inflammation of the membrane covering the brain (meninges), leading to meningitis.
Due to the complications and hydra-headed problems that disseminated infections cause, diagnoses too usually follows multi-step approaches which could encompass microbiological, immunological and histological tests. These would include finding the point of entry and initial site of infection, locating the various affected and infected tissues, deciding whether the infection is immune-mediated, and checking for secondary or co-infection(s). All these would involve endlessly taking samples from the patient, which may include blood, tissues, swabs (oral, vaginal and other mucosal surfaces) and cerebrospinal fluid.
In addition to this, treatment too would be multi-pronged, with the initial ones directed to relieve the symptoms before the results of the various tests are ready. Antibiotics, pain-relievers and all sorts of drugs would bombarded by the clinicians in order to find solutions to the ailments, which might even be worse off if the results are delayed due to various factors. In extreme cases, toxic drugs, meant for life-threatening cases, might be given to stem the tide of the infection if the initial drugs are not functioning. This too might complicate matter further if care is not taken.
All these would not take place if appropriate steps had been taken to treat the initial infections and prevent complications. People are therefore advised to seek medical help at the first notice of infection, no matter how mild or self-limiting it is thought to be, before it becomes more established. Prevention is better than cure, and that saying has never been more appropriate than in this kind of situation.