The aggressive disease

Danielle Loader rarely talks about her life-threatening battle with meningococcal septicaemia. Nine years on the trauma remains very real, as Kate Buchanan discovers.

News that Invercargill teenager Sara Loo had lost her courageous battle with meningococcal septicaemia last week struck at the hearts of many.

For a young Invercargill woman and her family it sparked a flood of emotions – the realisation she cheated death understandably the most compelling.

In 2002, Danielle Loader, then a 15-year-old James Hargest High School student, waged her own war against the deadly disease.

"It was hard seeing Sara Loo in the paper the other day. I just felt terrible for her and her family," an emotional Miss Loader, 23, said.

"When I first heard about it, I wrote a message on her Facebook page telling her to stay strong. Seeing Sara's situation made me realise how lucky I am."

While some memories of the illness were "blurry", the intense parts remained vivid.

"I remember waking up and looking at all the needles in my arms. It was a scary environment to wake up in. I felt like I was just away with the fairies the whole time," she said.

"And I remember the walls were really white and boring and there was only one stupid picture to look at."

Miss Loader's ordeal started with vomiting and cramp in her leg one night.

"It was intense cramp – it was really painful," she recalled.MOTHER'S intuition prompted Debbie Jamieson to check on her daughter from work the next day and, propelled by the lethargic response that greeted her on the other end of the phone, she rushed Miss Loader to Dr Stephen Voss at the Victoria Avenue Medical Centre.

"There was one little spot (on her stomach). I remember him saying there was a 99 per cent chance she was okay but there was always that 1 per cent so he wanted to send her to hospital," Mrs Jamieson said.

"She walked in (to his surgery) and got carried out because she collapsed. That's how quick it was."

Miss Loader was immediately rushed to Southland Hospital.

"She started coming out in spots right in front of us. Within five minutes they were running through the corridors up to isolation in intensive care and she was there for three weeks.

"It was just awful," Mrs Jamieson said.

A lasting memory is constantly rubbing her daughter's feet.

"Her hands and legs were frozen. The septicaemia takes all the blood away from your extremities."

"I remember they were going to cut my leg off," Miss Loader said.

The nightmare continued for Mrs Jamieson.

"The doctor said to me `I think we're going to lose her tonight' and I just vomited everywhere and nearly fainted. I couldn't handle it.

"They wanted to fly her to Auckland but didn't think she would survive the transfer."

Miss Loader's allergy to antibiotics complicated the situation.

"They said it was life or death. If she had a reaction to the antibiotics that was too bad but it wouldn't be as bad as what the meningitis could do," Mrs Jamieson said.

"For three weeks, they kept saying `she's not out of the woods'. With meningitis you just get over one thing and then something else happens. You think you're never going to get through it and you're on a knife-edge the whole time."

The struggle didn't end when Miss Loader was finally discharged home. It was three months before she could walk again and initially she could only eat through a straw.

"When you stood up, it was more the blood rushing back in after being poisoned. It was the most horrific thing – the nerves coming back to life," she said.

"It sucked (at the time) because everyone from school knows me as the girl that had meningitis.

"It was hard going back to school and limping. I had friends walking either side of me and if anyone said anything, they'd just snap at them."

She has since studied fashion design in Christchurch, showcased her creations at the Hokonui Fashion Awards as a 17-year-old and is presently completing a Degree in Business at the Southern Institute of Technology.

Now a mother herself to 4-year-old daughter Pagan, Miss Loader's message is simple.

"Don't underestimate it. If you're sick, go to the doctor, even if it is expensive.

"It's worth it because I didn't feel like I was dying. I thought `I'm okay, it's just a bug' but meningitis is really fast, I can't believe how fast it was," she says.

Mrs Jamieson says she hopes by sharing their story, it will continue to raise awareness about the disease.

"If you share lip gloss, drinks, ice blocks – that can be enough to contract it," she says.

"Never hesitate in taking your child to the doctor. Don't wait for the spots. They were the last thing to come out and if we'd waited, it could have been too late."NEWS of Sara's death also struck at a personal level with Asha Dutt, who battled bacterial meningitis in January 2007 and had been following the teenager's progress on Facebook.

"I was quite devastated to hear the news," she says. "It really conjured up a lot of emotions for me. I got a second chance where other people haven't been so lucky."

The partner of Invercargill Mayor Tim Shadbolt, Miss Dutt says the sheer speed at which the illness struck was alarming.

Waking with flu-like symptoms, including a severe headache, it progressed rapidly.

Just a few hours later, Miss Dutt barely had time call for an ambulance before she lost consciousness. She awoke in the ICU at Southland Hospital.

"You wake up with people wearing masks and gowns and machines everywhere.

"It's all quite scary," she says.

The harrowing experience took its toll on Mr Shadbolt and close friends at the time.

"I actually think it's worse for the people around you. I did come close to death," Miss Dutt says.

"It was devastating for him and close friends who had to sit and watch me go through it."

Swift action and early detection of the disease were integral to her quick recovery and Miss Dutt urges people to seek help if they exhibit symptoms.

"It's not a condition of the elderly. It can strike healthy young people without warning."DR Massimo Giola has witnessed some truly dreadful illnesses during his career. It goes with the territory when you specialise in infectious diseases. He describes meningococcal septicaemia as devastating.

"Meningococcal septicaemia is indeed a scary disease," Dr Giola says. "It can be so rapidly progressing that it can kill a previously fit and healthy young person in a few hours.

"The introduction of antibiotics has dramatically improved the outcomes, but even under optimal conditions the expected mortality is still around 8 to 10 per cent."

A consultant physician at Southland Hospital for the past two years, Dr Giola says it is a difficult illness to treat.

"It can progress so quickly to jeopardise any effort to get on top of it," he says.

"I have seen several dozens of cases during my career and I remember a few cases when it was really devastating – especially when a young and healthy person is carried away so quickly or left seriously maimed for the rest of their lives.

"We tend to forget that infectious diseases can be so dangerous but even today they account for a significant proportion of mortality worldwide – and in developed countries as well."

Educated in his native Italy, Dr Giola graduated from medicine in 1991 and completed his specialty in infectious diseases at the University of Pavia, one of the most ancient universities in Europe, in 1996. He then obtained a PhD in Clinical and Experimental Pharmacology in 2008, before shifting to New Zealand the following year.

"I chose infectious diseases because I was fascinated by the microbes and how we can fight them," he says. "During those years the Aids epidemic in Italy was at its peak, so it was a very exciting moment for new drugs and new treatments to be implemented."

New Zealand has been witnessing an epidemic of invasive meningococcal disease since the early 1990s: the case rate soaring from 1.6 per 100,000 people in 1990 to 16.9 per 100,000 in 1997. The predominant strain remains the serotype B, which accounted for 84 per cent of cases in 2000.

Otago-Southland medical officer of heath Dr Derek Bell says there have been three confirmed cases of meningitis in the combined southern region so far this year.

Sara's death was the first since July last year, when a 14-year-old Cromwell teenager died from the disease. In 2008, it claimed the life of a 10-month-old Southland baby.

Figures for the region show 19 cases in 2005, 16 in 2006, seven in 2007, 10 in 2008 and eight last year.

Dr Bell believs the meningococcal B immunisation programme introduced nationally in 2004 is having an impact.

According to Health Ministry figures, 370 meningococcal B strain cases were recorded nationally at the peak of the epidemic in 2001. By 2007, three years after the immunisation programme was launched, that figure had fallen to 47.

"It would appear the vaccination campaign has been very successful but it's not going to completely eradicate the disease," Dr Bell says.

"The numbers were coming down a little bit before the vaccination campaign started but we simply don't know if they would have continued to fall without the campaign."

He urges people not to get complacent about meningococcal.

"There will always be different strains of meningococcal that the vaccines don't get and there will always be a small number of people for whom the vaccination doesn't work entirely."

It is a message reinforced by Dr Giola.

"The vaccine, despite not being active against all the strains, is the best preventive measure that we have and I strongly recommend to the public not to be complacent but to actively take the opportunity to get their vaccines – not only against meningococci but against the flu, as well, as that often opens the door for them," he said.

Prompt medical attention is vital if a child or teenager is acutely unwell, feverish, sleepy, nauseated and complaining of a severe headache.

An "alarming sign", a petechial rash, can be present – a skin eruption of red, discrete lesions of 1-2mm in diameter, which are non-blanching (they don't go away if observed through a glass exerting a gentle pressure on the skin).

"What often doesn't appear in the list of classic symptoms is the concept of it usually having rapid progression of symptoms," Dr Bell says. "It can be extremely aggressive in some people but, caught early, treatment is usually very successful."

- © Fairfax NZ News