Alarming concerns of possible bacterial meningitis outbreak in Denver area school district

Three staff members within the Cherry Creek School District have died in the last two weeks—with reports saying that at least one had symptoms consistent with bacterial meningitis (BM). The district is located in Greenwood Village, which sits in the Denver, Aurora, and Lakewood, CO area. 

Madelaine Michelle Schmidt, 24, and Judith Briere Geoffroy, 63, were both staff members at Eagle Crest High School. Schmidt was a teacher in the school’s Integrated Learning Center, and Geoffroy was a paraprofessional at the school. They both died two weeks ago. 

According to an April 13 news report from CNN, the causes of death are pending—and  “they were unable to confirm the absence or the presence of bacterial meningitis” in the case of Schmidt and Geoffroy. However, an April 12 report from The Denver Gazette says suspicions of Schmidt’s BM were confirmed through lab testing.^[] []

A third teacher, Scott Nash—who taught at an elementary school in the district—also died. However, the Denver Post reports that Nash’s death was entirely unrelated and that BM was not suspected. Still, a coroner is set to confirm this, news reports say.^[] 

Local officials are unsure if Schmidt’s case is singular or if it was connected to an outbreak. They are also now working to trace any contact the teachers may have had with others. The Denver Gazette also reports that the local public health chief medical officer, Chris Urbina, says the BM risk to public health is low. 

Bacterial meningitis: an overview

Meningitis is an infection of the membranes around the spinal cord and brain. When infected, these membranes press on the spinal cord or brain, potentially leading to brain damage, paralysis, stroke, or death. 

Both bacteria and viruses can cause meningitis, although BM is more dangerous. It also occurs less frequently than viral meningitis, however, with BM seeing about 2,600 cases per year in the United States.^[] The World Health Organization states that one in 10 people with BM will die from it while one in five will have severe complications.^[]

Erica Susky, an infection control practitioner in hospital epidemiology and teacher at Infection Prevention and Control Canada, explains that certain bacterias are more common in BM, including Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae and Mycobacterium tuberculosis. It’s worth noting that six types of Neisseria meningitidis—A, B, C, W, X, and Y—are the most frequent causes of BM worldwide.^[] 

Susky says BM often spreads in close quarters, like schools, dormitories, or healthcare settings—typically via saliva droplets. Typically, it requires repeated and lengthy exposure.^[] 

Other times, exposure comes from within a healthcare setting itself. “This form of meningitis is caused by neurological procedures such as neurosurgery. In this case, a portal of entry for bacteria was made by the healthcare procedure allowing bacteria from the patient or healthcare worker to enter into a normally sterile site of the body,” Susky says. 

Diagnosing bacterial meningitis

Ken Perry, MD, FACEP, an emergency physician, says your patients with BM may present with “fever, headaches, and neck pain—but [they] can also progress to include altered mental status as well as in some cases a very concerning dark purple rash.” Nausea and vomiting, cold hands and feet, and diarrhea may also occur. Symptoms may begin either suddenly or gradually.^[]

In infants, you’ll want to look out for inconsolability, poor eating, swelling in the fontanelle, a floppy body, slow movements, or stillness, says the World Health Organization.^[]

Diagnosing BM requires a lumbar puncture to collect cerebrospinal fluid (CSF) sample. For a physician investigating suspicion of BM, Perry says to be on the lookout for spinal fluid that appears cloudy or pus-like. “The CSF can also be analyzed for its biochemical and cellular content for indirect evidence of microbial growth or an immune response (white blood cells, proteins, and sugars among other things),” Susky adds. “A polymerase chain reaction can also be done on the CSF to look for the presence of viruses that can cause these infections.”

Patients with BM may be of any age, although young children and newborns are often at risk. Immunocompromised patients or patients who smoke may also be at greater risk.^[] Additionally, it’s important to confirm if patients with suspected BM have recently traveled to sub-Saharan African areas where meningitis is reported (from Ethiopia across to Senegal), or if they visited Mecca during certain pilgrimages.

“As an emergency department physician, meningitis is on the differential whenever a patient presents with fevers, headache, and neck pain,” Perry adds. However, he stresses that the likelihood of actually seeing a BM diagnosis is very low—a fact backed by the statistics. 

“Most patients end up having upper respiratory infections or other infections that cause myalgias (muscle aching) that causes pain in the neck,” he says. 

Prevention is the name of the game

Prevention is key, Susky stresses—and this comes down to immunization. “It is important for all to know what vaccines are available and to remain up to date in all of their vaccines,” she says. The vaccine can prevent meningitis disease stemming from meningococcus, pneumococcus haemophilus, and influenzae type b.

“Sometimes close exposures need prophylactic antibiotics so that they are not at risk of exposure to certain pathogens causing bacterial meningitis. Informing the public will ensure that high-risk contacts get their antibiotic exposure prophylaxis,” Susky says. 

Managing patient concern

Perry recommends reminding your patients that while news stories of BM are alarming, the statistics around BM’s rate of occurrence should guide anxiety levels. “Any time these very concerning diseases arise [in the news]—especially those that have deaths associated with them—the public obviously gets concerned. That being said, there is a need to have some perspective on how likely it is to contract this disease,” Perry says.