Acute meningitis (swelling of the covering of the brain) is a life threatening illness and is in the news this week because
UML leader KP Oli has been admitted to the hospital for its treatment.
But imagine suffering from meningitis 14 times and surviving to tell the story. That is exactly what happened to 50-year-old Palden Lama (name changed) from Samagaon in the Budi Gandaki Valley. He had come to Kathmandu when he suddenly suffered severe headache, fever and vomiting
After a series of laboratory tests including a spinal tap to test the cerebrospinal fluid (CSF) which bathes the brain, he was diagnosed with meningitis and was subsequently treated with antibiotics.
His treating physician, Buddhi Paudyal, noted that the bacteria (Neisseriae meningitides) was well known for causing meningitis. Fortunately, the patient improved rapidly and went home.
But he returned with similar complaints again and again. In fact, it became an annual ritual for Palden to come to Patan Hospital and be treated with antibiotics.
Amazingly, he was cured of his illness each time, without any medical complications such as stroke and deafness.
Palden then went to South Korea as a migrant worker. He was wise enough to have a legible note in English from his Nepali doctor stating clearly that he suffered from recurrent meningitis which responded well to a set of antibiotics. He had two bouts of meningitis in South Korea.
The doctors there had to perform so many spinal taps that he decided to return to Nepal. The spinal tap is an invasive procedure, and for many, a painful one; but the procedure is absolutely essential to make the diagnosis.
Perhaps the South Korean doctors wanted to monitor him more closely, resulting in more spinal taps than he wanted.
When he returned to Kathmandu, he again met Paudyal at Patan Hospital who strongly advised a special high resolution CT scan of his head to detect any leakage of the CSF fluid to account for repeated meningitis. Sure enough, a tiny break (dehiscence) at the base of his skull was detected which communicated directly with the back of his nose (nasopharynx). So, bacteria from the back of his nose in all likelihood travelled to the brain through the gap to cause these repeated bouts of meningitis.
As though confirming this, Palden again went to Patan Hospital with headache and fever, as well as what he termed “mineral water” like discharge from only one side of his nose. His wife told him that this was indeed very strange, that without catching a cold he had this colorless discharge from his nose. Paudyal promptly sent the nasal discharge to the laboratory.
A simple microscopic study of the material revealed that the discharge was CSF fluid tracking down from the hole in the base of his skull to his nose. He was referred to eminent neurosurgeon Upendra Devkota, who skillfully repaired the dehiscence at the base of the skull. Palden recovered safely and has been meningitis free for many years now.
Stories like this are probably common in Nepal, where an astute clinician and a competent surgeon work together to help a patient in need. Many years ago, this level of diagnostic sophistication and treatment was unavailable here.
But suffering from meningitis 14 times must be a world record good enough for the Guinness book to consider.
Read also:
A narrow escape
Meningitis again?