On a Friday night in October 1999, Michigan State sophomore Adam Busuttil felt a cold coming on, so he decided to leave his friends and get back to his dorm early and get some rest before the Saturday Michigan State football game, where he played in the marching band.
But the next morning, Busuttil felt worse, and decided to stay home from the game.
By the afternoon, Busuttil had passed out in the shower, hitting his arm and head during the fall.
And by Saturday night, Busuttil was rushed to the emergency room; his fever had spiked, his blood pressure dropped to 50 over 15 and his feet and fingers had turned black from sepsis, a poisoning of the blood that is often triggered in bacterial meningitis patients.
After being diagnosed with bacterial meningitis, Busuttil's doctors amputated portions of seven of his fingers, his big toe and parts of his other toes on his left foot.
Busuttil also suffered from brain damage that left him relearning how to perform daily tasks.
"I had to learn how to tie my shoe, open a door, write," said Busuttil, who is now a 30-year-old elementary school music teacher. "It was pretty intense."
Busuttil returned to Michigan State the following year, where he rejoined the marching band and earned his degree.
Meningitis is an inflammation of the membranes that cover the brain and spinal cord, and is usually caused by a viral or bacterial infection. Viral meningitis tends to be less severe than bacterial.
Bacterial can cause brain damage, hearing loss, learning disabilities and even death, sometimes in a matter of hours.
According to the National Meningitis Association, about 1,500 Americans were diagnosed with meningitis each year between 1998 and 2007, and 11 percent died of the illness.
Among those who survived, about 20 percent suffer from long-term side effects, including brain damage, kidney disease, hearing loss or limb amputations.
"The numbers aren't that high, but when one of them is your kid, it doesn't matter what the numbers are," said Kelly Madison, president of the Meningitis Foundation of America.
Now, the New York City Department of Health and Mental Hygiene is reporting six new cases of bacterial meningitis, the same illness that Busuttil survived more than a decade ago.
Two Manhattan women in their 20s and a Staten Island woman in her 50s died from the illness in the past month.
The six patients ranged in age, from 4 to 74, but health officials said that strains of the infection were different and not likely linked.
In response to the six cases, the New York City Department of Health and Mental Hygiene sent a memo to health care providers across the city to remind doctors and nurses to report meningitis cases as soon as possible.
"We sent out an alert to remind doctors to report a meningococcal case immediately, and also to remind them that, especially at this time of year, meningococcal disease can look like the flu and other things," said Dr. Donald Weiss, director of surveillance for bureau of communicable disease investigator for the New York City Department of Health and Mental Hygiene.
While the six cases were not likely related, Weiss said that it's important for physicians to keep meningococcal disease on their radar, especially during cold and flu season.
In hearing about the recent New York cases, Busuttil said: "Information is most important thing when it comes to meningitis. A lot of times, until there is a case, many people don't even know what it is, and it's sad that there has to be a fatality to make people aware of it."
Warning signs of meningitis include fever, headache, nausea, fatigue, eye sensitivity to light, stiff neck, confusion and a purple skin rash that usually covers large parts of the limbs.
"A lot of these meningitis cases can feel like the carton variety flu, so it can be quite difficult to pinpoint, that's why you should look for things like severe headache and stiff neck, " said Dr. Lee Harrison, professor of medicine and epidemiology at the University of Pittsburgh Medical Center. "And the rash [along with other symptoms] should be an immediate red flag."
Once doctors believe a patient may have meningitis, they must perform a spinal tap immediately. There, physicians can diagnosis meningococcal disease, and whether it is the viral or bacterial variety.
"Identifying symptoms early on and seeking medical attention early in bacterial meningitis can make a big difference in life or death," said Dr. Adarsh Bhimraj, head of the section of neurologic infections at Cleveland Clinic.
If bacterial, doctors administer the appropriate antibiotics and steroids. There is no treatment available for viral meningitis except for pain relief. But doctors said it is quite rare for a patient to die of viral meningitis.
The Advisory Committee on Immunization Practices currently recommends that all people ages 11 to 18 years old receive the meningitis vaccine. The immunization protects every bacterial meningitis strain except for the B strain.
New York State requires that all college and university students be educated on meningitis and the vaccine. While students are not required to receive the vaccine, but those who do not want it must decline in writing or by electronic signature.
College freshmen living in dormitories are at a slightly increased risk of bacterial meningitis, which is spread through droplets from sneezing and coughing, kissing and sharing utensil and beverages. Viral meningitis is caused by an enterovirus, a virus that enters the body through the gastrointestinal tract and often moves on to attack the nervous system.
The Meningitis Foundation of America's Madison agreed with Busuttil that awareness is key in preventing the disease.
"A lot of us are becoming advocates of our own health care," said 42-year-old Madison, who suffered from viral meningitis in 1998. "Know what [meningitis] looks like and be armed with as much information as you can be."
"Believe me," said Madison. "nothing would make me happier than to be out of a job, and be able to tell people that meningitis no longer exists."