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Adawe DH, Mengistie DT. Determine the factors affecting the time to recovery of children with bacterial meningitis at Jigjiga university referral hospital in the Somali Regional State of Ethiopia: using the parametric shared frailty and AFT models. BMC Res Notes 2024; 17:85. [PMID: 38504305 PMCID: PMC10953244 DOI: 10.1186/s13104-024-06740-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/08/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Neisseria meningitides, Streptococcus pneumonia, and hemophilic influenza type B are frequently linked to bacterial meningitis (BM) in children. It's an infectious sickness that kills and severely mobilizes children. For a variety of reasons, bacterial meningitis remains a global public health concern; most cases and deaths are found in Sub-Saharan Africa, particularly in Ethiopia. Even though vaccination has made BM more preventable, children worldwide are still severely harmed by this serious illness. Age, sex, and co-morbidity are among the risk variables for BM that have been found. Therefore, the main objective of this study was to identify the variables influencing the time to recovery for children with bacterial meningitis at Jigjiga University referral hospital in the Somali regional state of Ethiopia. METHOD A retrospective cohort of 535 children with bacterial meningitis who received antibiotic treatment was the subject of this study. Parametric Shared Frailty ty and the AFT model were employed with log likelihood, BIC, and AIC methods of model selection. The frailty models all employed the patients' kebele as a clustering factor. RESULTS The number of cases of BM declined in young children during the duration of the 2 year, 11 month study period, but not in the elderly. Streptococcus pneumonia (50%), hemophilic influenza (30.5%), and Neisseria meningitides (15%) were the most frequent causes of BM. The time to recovery of patients from bacteria was significantly influenced by the covariates male patients (ϕ = 0.927; 95% CI (0.866, 0.984); p-value = 0.014), patients without a vaccination history (ϕ = 0.898; 95% CI (0.834, 0.965); P value = 0.0037), and patients who were not breastfeeding (ϕ = 0.616; 95% CI (0.404, 0.039); P-value = 0.024). The recovery times for male, non-breastfed children with bacterial patients are 7.9 and 48.4% shorter, respectively. In contrast to children with comorbidity, the recovery time for children without comorbidity increased by 8.7%. CONCLUSION Age group, sex, vaccination status, co-morbidity, breastfeeding, and medication regimen were the main determinant factors for the time to recovery of patients with bacterial meningitis. Patients with co-morbidities require the doctor at Jigjiga University Referral Hospital to pay close attention to them.
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Affiliation(s)
- Daud Hussein Adawe
- Department of Statistics, College of Natural and Computational Science, Jigjiga University, Jigjiga, Ethiopia
| | - Dagne Tesfaye Mengistie
- Department of Statistics, College of Natural and Computational Science, Jigjiga University, Jigjiga, Ethiopia.
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Bacha T, Obremskey A, Buxton J, Fink EL, von Saint Andre-von Arnim A, Raees M. Practice patterns in pediatric infectious encephalopathy in four centers in Africa. Front Pediatr 2024; 12:1304245. [PMID: 38464900 PMCID: PMC10920287 DOI: 10.3389/fped.2024.1304245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/02/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Infectious encephalopathy (IE), including meningitis, infectious encephalitis, and cerebral abscess, remains prevalent and carries high mortality and morbidity in children, especially in low and middle income countries (LMIC). This study aims to describe the usual care and outcomes of pediatric IE in four LMIC hospitals in sub-Saharan Africa to support evidence-based care guideline development. Methods This is a secondary analysis of the Prevalence of Acute Critical Neurological disease in children: A Global Epidemiological Assessment-Developing Countries study, a 4-week, prospective, observational study in children (1 week to 17 years) with IE presenting to referral hospitals in Ethiopia, Kenya, Rwanda, and Ghana. Data collection included diagnostic testing, interventions, and patient outcomes [e.g., mortality, Pediatric Cerebral and Overall Performance Category Scores (PCPC and POPC)]. Results Seventy-two children with IE were enrolled. Most patients were diagnosed with undifferentiated IE (78%, n = 56). Specific etiologies included cerebral malaria (10%, n = 7), viral encephalitis (4%, n = 3), tuberculosis (4%, n = 3), bacterial meningitis (3%, n = 2), and cerebral abscess (1%, n = 1). Fourteen patients (20%) had a head computed tomography performed. Thirty two (44%) children had a lumbar puncture but only 9 samples (28%) were sent for culture. Median time from diagnosis to antimicrobial therapy was 3 h (IQR 1-12 h). Half (51%, n = 33) of inpatients received intracranial pressure (ICP)-directed treatment but none underwent ICP monitoring. Mortality was 13% (n = 9). The percentage of children with a favorable cognitive score decreased from 95% (n = 62) prior to admission to 80% (n = 52) and 77% (n = 50) at discharge for PCPC and POPC respectively. Discussion IE led to considerable morbidity and mortality in this cohort, and evaluation and management varied across the care continuum. Resource limitations and diagnostic constraints may have affected diagnosis-directed therapy and other aspects of management. Further studies are needed to describe the epidemiology and management of IE in LMICs to inform future treatment protocols, the role of technological and human capacity building to support both basic monitoring and interventions, as well as creative new solutions to emergency and critical care in these settings.
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Affiliation(s)
- Tigist Bacha
- Department of Pediatrics and Child Health, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Alexandra Obremskey
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jessica Buxton
- Department of Molecular and Cell Biology, University of California, Berkeley, CA, United States
| | - Ericka L. Fink
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Amelie von Saint Andre-von Arnim
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Washington, Seattle Children’s, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Madiha Raees
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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Basatemur E. Bacterial meningitis in children. BMJ 2023; 381:728. [PMID: 37225238 DOI: 10.1136/bmj.p728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Risk Factors for Severe Outcomes in Bacterial Meningitis. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-110134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: This study aimed to define risk factors associated with suppurative complications, short-term sequelae, and death in pediatric patients with bacterial meningitis. Methods: A retrospective cohort study was conducted on children with bacterial meningitis, aged 0 months to 18 years, who were admitted to the Hospital Infantil João Paulo II, reference in infectious diseases, from 2005 to 2018. Results: In 178 cases, meningococcal meningitis was the most prevalent disease form (51%), followed by pneumococcal meningitis (31%) and Haemophilus influenzae type B meningitis (10%). The main clinical findings at admission were fever (93.1%), vomiting (67.9%), drowsiness (47.8%), headache (36.5%), irritability (28.3%), and seizures (26.4%). Suppurative complications were recorded in 19% of the patients. The prevalence of neurological sequelae during hospital discharge was 12.4%. Hearing (41%; n = 9) and cognitive (9%) impairments were prominent among the diagnosed sequelae. Incidences of epileptic crises, vestibular disorders, or hydrocephalus were noted in one case each (4.5%), and 12.4% of the patients died. Conclusions: Streptococcus pneumoniae and H. influenzae type B were associated with the diagnosis of sequelae during hospital discharge, seizures were considered a risk factor for suppurative complications, and gastrointestinal symptoms or signs of clinical severity were associated with death.
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Rahimi BA, Ishaq N, Mudaser GM, Taylor WR. Outcome of acute bacterial meningitis among children in Kandahar, Afghanistan: A prospective observational cohort study. PLoS One 2022; 17:e0265487. [PMID: 35404980 PMCID: PMC9000062 DOI: 10.1371/journal.pone.0265487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Acute bacterial meningitis (ABM) is an important cause of morbidity and mortality in children but there are no published data on the treatment outcomes of ABM in Afghanistan. METHODS We conducted a prospective observational cohort study over one year, February 2020 to January 2021 in a tertiary care hospital in Kandahar, Afghanistan. AMB was diagnosed clinically and on lumbar puncture findings. Binary logistic regression assessed factors for death. RESULTS A total of 393 ABM children of mean age 4.8 years were recruited. Most were males [231 (58.8%)], living in rural areas [267 (67.9%)] and in households of >10 inhabitants [294 (74.8%)]. Only 96 (24.4%) had received against both Haemophilus influenzae type b (Hib) or pneumococcal (PCV) vaccines. Children were treated with combination of ceftriaxone and ampicillin and 169/321 (52.6%) received dexamethasone. Of the 321 children with a known outcome, 69 (21.5%) died. Death was significantly associated with: not receiving dexamethasone [adjusted odds ratio (AOR) 4.9 (95% CI 2.6-9.5, p <0.001)], coma on admission [AOR 4.6 (I 2.3-9.5, p <0.001)], no PCV [AOR 2.8 (1.2-6.6, p = 0.019)] or Hib vaccine [AOR 2.8 (1.2-6.6, p = 0.019)], and being male [AOR 2.7 (1.4-5.5, p = 0.005). CONCLUSIONS ABM causes significant morbidity and mortality in Afghan children that may be improved by greater use of PCV and Hib vaccines. Adjunct dexamethasone should be evaluated formally in our setting.
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Affiliation(s)
- Bilal Ahmad Rahimi
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
- Research Unit of Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Niamatullah Ishaq
- Department of Radiology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | | | - Walter R. Taylor
- Mahidol Oxford Tropical Medicine Clinical Research unit (MORU), Mahidol University, Bangkok, Thailand
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Zheng G, Shi Y, Cao Y, Qian L, Lv H, Zhang L, Zhang G. Clinical Feature, Therapy, Antimicrobial Resistance Gene Distribution, and Outcome of Nosocomial Meningitis Induced by Multidrug-Resistant Enterobacteriaceae-A Longitudinal Cohort Study From Two Neurosurgical Centers in Northern China. Front Cell Infect Microbiol 2022; 12:839257. [PMID: 35444955 PMCID: PMC9013899 DOI: 10.3389/fcimb.2022.839257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/10/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives This is a comparative cohort study aiming to evaluate the mortality risk factors for patients with nosocomial meningitis (NM) induced by multidrug-resistant Enterobacteriaceae (MDRE) in China. The clinical features and therapies of patients and the resistance mechanisms of MDRE pathogens were also assessed. Methods MDRE-NM patients from two neurosurgical centers in China from 2014 to 2019 were included in this study. Clinical features were extracted from the medical record databases of the two centers. The molecular mechanisms underlying the microbiological resistance mechanisms of each MDRE pathogen were determined, Kaplan-Meier survival analysis was conducted, and multivariable analyses were performed using a Cox proportional hazard model. Results Ninety MDRE-NM patients were included in this study. Klebsiella pneumoniae accounted for the highest proportion of causative pathogens (46/90, 51.1%), and 40 causative pathogens (44.4%) were meropenem-resistant. blaKPC (27/40, 67.5%) was the predominant carbapenem resistance gene. Multivariate Cox analysis showed that external ventricular drainage (EVD) [hazard ratio (HR) = 2.524, 95% confidence interval (CI) = 1.101-5.787, p = 0.029] and a Glasgow Coma Scale (GCS) score ≤;8 (HR = 4.033, 95% CI = 1.526-10.645, p = 0.005) were mortality risk factors for patients with MDRE-NM. A total of 90.0%, 94.4%, and 97.8% of MDRE-NM patients received antibiotic prophylaxis (AP), antibiotic empirical therapy (AET), and antibiotic definitive therapy (ADT), respectively. Conclusions NM caused by MDRE is an important sign of the failure of neurosurgery. MDRE possesses multiple drug resistance genotypes, and EVD and a GCS score ≤;8 are independent mortality risk factors for patients with MDRE-NM, which deserve the attention of microbiologists and neurosurgical clinicians.
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Affiliation(s)
- Guanghui Zheng
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, China
| | - Yijun Shi
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China
| | - Yanfei Cao
- Department of Clinical Diagnosis Laboratory of Daqing Oilfield General Hospital Clinical Laboratory, Daqing, China
| | - Lingye Qian
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China
| | - Hong Lv
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, China
| | - Lina Zhang
- Department of Clinical Diagnosis Laboratory of Daqing Oilfield General Hospital Clinical Laboratory, Daqing, China
| | - Guojun Zhang
- Department of Clinical Diagnosis, Laboratory of Beijing Tiantan Hospital and Capital Medical University, Beijing, China
- NMPA Key Laboratory for Quality Control of In Vitro Diagnostics, Beijing, China
- Beijing Engineering Research Center of Immunological Reagents Clinical Research, Beijing, China
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Li D, Zhang X, Wang Y, Xue J, Ji X, Shao X, Li Y. Epidemiology and Drug Resistance of Pathogens Isolated from Cerebrospinal Fluids at a Children's Medical Center in Eastern China During 2006-2020. Infect Drug Resist 2021; 14:5417-5428. [PMID: 34949927 PMCID: PMC8689011 DOI: 10.2147/idr.s344720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the epidemiology and drug resistance of pathogens isolated from cerebrospinal fluid samples at a children's medical center in eastern China and provide the basis for anti-infection treatments. Methods In all, 307 non-duplicated strains of pathogens were isolated from cerebrospinal fluid samples in the Children's Hospital of Soochow University from January 2006 to December 2020. Mass spectrometry was used for pathogen identification. The VITEK 2 Compact system and Kirby-Bauer method were applied to determine antimicrobial susceptibility. Results Among the 307 isolates, gram-positive bacteria, gram-negative bacteria and fungi accounted for 60.26%, 34.53%, and 5.21%, respectively. The most prevalent pathogens were Streptococcus pneumoniae (26.06%), Escherichia coli (20.20%) and Streptococcus agalactiae (17.26%). The number of isolates was highest in winter. The most prevalent gram-positive bacterium in children <6 months old was Streptococcus agalactiae, while Streptococcus pneumoniae was the most in children were >6 months old. The drug resistance of gram-positive bacteria, fungi and Haemophilus influenza were not high. In addition, 35 strains of gram-negative bacteria produced extended-spectrum β-lactamases (ESBLs) and 6 strains were identified as multidrug-resistant (MDR) bacteria. These strains showed much higher resistance to the antibiotics than other strains. Conclusion Cases of meningitis among children have increased in the past 15 years and MDR bacteria were also identified. The emergence of MDR bacteria is a cause for great concern and requires further investigation.
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Affiliation(s)
- Dan Li
- Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, People's Republic of China
| | - Xin Zhang
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China.,Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Yunzhong Wang
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Jian Xue
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Xueqiang Ji
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Xuejun Shao
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China.,Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China.,Clinical Medical College of Pediatrics, Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
| | - Yang Li
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China.,Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China.,Clinical Medical College of Pediatrics, Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China
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Zhou T, Kuang M, Huang S, Li J, Xie Q. Epidemiological Characteristics and Drug Resistance Analysis of Cerebrospinal Fluid Microbial Infections in Wenzhou Area. Infect Drug Resist 2021; 14:2091-2103. [PMID: 34113136 PMCID: PMC8184139 DOI: 10.2147/idr.s312175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023] Open
Abstract
Objective Central nervous system infections (CNSI) are serious diseases that endanger human health. Identifying pathogens and their susceptibility to antibiotics, and promptly using antibiotics under this guidance is essential for treatment. The purpose of this study is to investigate the pathogen characteristics of CNSI patients, which can help clinicians choose appropriate empiric antibiotic . Methods We retrospectively collected data on CNSI patients with cerebrospinal fluid (CSF) culture positive from 2012 to 2020, including demographic characteristics, laboratory data, pathogenic bacteria, and antimicrobial susceptibility test results. Results A total of 166 patients with 168 isolates out of 8188 patients were available for data analysis. Among the isolates, Gram-positive bacteria, Gram-negative bacteria and fungi accounted for 59.5%, 36.3%, and 4.2%, respectively. Among newborns, children under 12, and patients over 12, the most isolated strains were Streptococcus agalactiae (24/46, 52.2%), Streptococcus pneumoniae (21/68, 30.9%) and Staphylococcus epidermidis (10/54, 18.5%), respectively. Streptococcus agalactiae is more sensitive to linezolid and vancomycin. Streptococcus pneumoniae is more sensitive to vancomycin. Staphylococcus epidermidis is more sensitive to clindamycin and rifampicin. The sugar content in the CSF of Gram-negative bacteria of children ≤12 years old was significantly lower than that of Gram-positive bacteria (P<0.05). Conclusion We comprehensively studied the etiological characteristics and antimicrobial resistance patterns of positive cerebrospinal fluid cultures in Wenzhou City, Zhejiang Province from 2012 to 2020, which can provide valuable strategies for preventing pathogens and improving evidence-based treatment.
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Affiliation(s)
- Teng Zhou
- Department of Laboratory Medicine, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People's Republic of China.,The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, People's Republic of China
| | - Mengjiao Kuang
- Department of Laboratory Medicine, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People's Republic of China
| | - Shirui Huang
- Department of Laboratory Medicine, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People's Republic of China
| | - Jizhen Li
- Department of Laboratory Medicine, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People's Republic of China
| | - Qipeng Xie
- Department of Laboratory Medicine, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People's Republic of China
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Bacterial Meningitis in Children: Neurological Complications, Associated Risk Factors, and Prevention. Microorganisms 2021; 9:microorganisms9030535. [PMID: 33807653 PMCID: PMC8001510 DOI: 10.3390/microorganisms9030535] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 01/07/2023] Open
Abstract
Bacterial meningitis is a devastating infection, with a case fatality rate of up to 30% and 50% of survivors developing neurological complications. These include short-term complications such as focal neurological deficit and subdural effusion, and long-term complications such as hearing loss, seizures, cognitive impairment and hydrocephalus. Complications develop due to bacterial toxin release and the host immune response, which lead to neuronal damage. Factors associated with increased risk of developing neurological complications include young age, delayed presentation and Streptococcus pneumoniae as an etiologic agent. Vaccination is the primary method of preventing bacterial meningitis and therefore its complications. There are three vaccine preventable causes: Haemophilus influenzae type b (Hib), S. pneumoniae, and Neisseria meningitidis. Starting antibiotics without delay is also critical to reduce the risk of neurological complications. Additionally, early adjuvant corticosteroid use in Hib meningitis reduces the risk of hearing loss and severe neurological complications.
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Agossou J, Ebruke C, Noudamadjo A, Adédémy JD, Dènon EY, Bankolé HS, Dogo MA, Assogba R, Alassane M, Condé A, Mohamed FA, Kpanidja G, Gomina M, Hounsou F, Aouanou BG, Okoi C, Oluwalana C, Worwui A, Ndow PS, Nounagnon J, Mwenda JM, Sossou RA, Kwambana-Adams BA, Antonio M. Declines in Pediatric Bacterial Meningitis in the Republic of Benin Following Introduction of Pneumococcal Conjugate Vaccine: Epidemiological and Etiological Findings, 2011-2016. Clin Infect Dis 2020; 69:S140-S147. [PMID: 31505630 PMCID: PMC6761314 DOI: 10.1093/cid/ciz478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric bacterial meningitis (PBM) remains an important cause of disease in children in Africa. We describe findings from sentinel site bacterial meningitis surveillance in children <5 years of age in the Republic of Benin, 2011-2016. METHODS Cerebrospinal fluid (CSF) was collected from children admitted to Parakou, Natitingou, and Tanguieta sentinel hospitals with suspected meningitis. Identification of Streptococcus pneumoniae (pneumococcus), Haemophilus influenzae, and Neisseria meningitidis (meningococcus) was performed by rapid diagnostic tests, microbiological culture, and/or polymerase chain reaction; where possible, serotyping/grouping was performed. RESULTS A total of 10 919 suspected cases of meningitis were admitted to the sentinel hospitals. Most patients were 0-11 months old (4863 [44.5%]) and there were 542 (5.0%) in-hospital deaths. Overall, 4168 CSF samples were screened for pathogens and a total of 194 (4.7%) PBM cases were confirmed, predominantly caused by pneumococcus (98 [50.5%]). Following pneumococcal conjugate vaccine (PCV) introduction in 2011, annual suspected meningitis cases and deaths (case fatality rate) progressively declined from 2534 to 1359 and from 164 (6.5%) to 14 (1.0%) in 2012 and 2016, respectively (P < .001). Additionally, there was a gradual decline in the proportion of meningitis cases caused by pneumococcus, from 77.3% (17/22) in 2011 to 32.4% (11/34) in 2016 (odds ratio, 7.11 [95% confidence interval, 2.08-24.30]). Haemophilus influenzae meningitis fluctuated over the surveillance period and was the predominant pathogen (16/34 [47.1%]) by 2016. CONCLUSIONS The observed decrease in pneumococcal meningitis after PCV introduction may be indicative of changing patterns of PBM etiology in Benin. Maintaining vigilant and effective surveillance is critical for understanding these changes and their wider public health implications.
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Affiliation(s)
- Joseph Agossou
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | - Chinelo Ebruke
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Alphonse Noudamadjo
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | - Julien D Adédémy
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | - Eric Y Dènon
- Service National de Laboratoire Sante Publique, Cotonou
| | | | - Mariam A Dogo
- Service National de Laboratoire Sante Publique, Cotonou
| | | | | | - Abdoullah Condé
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | - Falilatou Agbeille Mohamed
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | - Gérard Kpanidja
- Department of Mother and Child, Faculty of Medicine, University of Parakou, Parakou, Benin.,Borgou Regional University Teaching Hospital, Parakou, Benin
| | | | | | - Basile G Aouanou
- Service National de Laboratoire Sante Publique, Cotonou.,Saint Jean de Dieu Hospital of Tanguieta, Benin
| | - Catherine Okoi
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Claire Oluwalana
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Archibald Worwui
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Peter S Ndow
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | | | - Jason M Mwenda
- WHO Regional Office for Africa, Brazzaville, Republic of Congo
| | | | - Brenda A Kwambana-Adams
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul
| | - Martin Antonio
- World Health Organization (WHO) Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Teixeira DC, Diniz LMO, Guimarães NS, Moreira HMDAS, Teixeira CC, Romanelli RMDC. Risk factors associated with the outcomes of pediatric bacterial meningitis: a systematic review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Teixeira DC, Diniz LMO, Guimarães NS, Moreira HMDAS, Teixeira CC, Romanelli RMDC. Risk factors associated with the outcomes of pediatric bacterial meningitis: a systematic review. J Pediatr (Rio J) 2020; 96:159-167. [PMID: 31437421 PMCID: PMC9432045 DOI: 10.1016/j.jped.2019.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The aim of this study was to systematically review the literature and answer the following central question: "What are the risk factors associated with worse clinical outcomes of pediatric bacterial meningitis patients?" METHODS The articles were obtained through literary search using electronic bibliographic databases: Web of Science, Scopus, MEDLINE, and LILACS; they were selected using the international guideline outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols. RESULTS The literature search identified 1,244 articles. After methodological screening, 17 studies were eligible for this systematic review. A total of 9,581 patients aged between 0 days and 18 years were evaluated in the included studies, and several plausible and important prognostic factors are proposed for prediction of poor outcomes after bacterial meningitis in childhood. Late diagnosis reduces the chances for a better evolution and reinforces the importance of a high diagnostic suspicion of meningitis, especially in febrile pictures with nonspecific symptomatology. S. pneumoniae as a causative pathogen was demonstrated to be related to clinical severity. CONCLUSIONS Early prediction of an adverse outcome may help determine which children require more intensive or longer follow-up and may provide the physician with rationale for parental counseling about their child's prognosis in an early phase of the disease.
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Affiliation(s)
- Daniela Caldas Teixeira
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Belo Horizonte, MG, Brazil.
| | - Lilian Martins Oliveira Diniz
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Infantil João Paulo II, Belo Horizonte, MG, Brazil; Faculdade de Medicina de Barbacena, Barbacena, MG, Brazil
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Amare AT, Kebede ZT, Welch HD. Epidemiology of bacterial meningitis in children admitted to Gondar University Hospital in the post pneumococcal vaccine era. Pan Afr Med J 2019; 31:193. [PMID: 31086637 PMCID: PMC6488968 DOI: 10.11604/pamj.2018.31.193.10254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/12/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Community acquired bacterial meningitis (CABM) is responsible for high mortality and disabling sequelae. Introduction of pneumococcal conjugate vaccine (PCV-10) and haemophilus influenzeatype b (Hib) has changed the epidemiological and clinical features of patients presenting with CABM as it is shown in different literatures over the last decade. The aim of this study was to assess the clinical and epidemiologic features and outcomes of CABM after the introduction of PCV-10 in Gondar University Hospital (GUH). METHODS This is a retrospective study among children between 2 months and 14 years of age discharged from Gondar University Hospital. All patient records discharged with a diagnosis of meningitis at GUH were reviewed from September 2011 - September 2013. The data was collected using a structured questionnaire from the patient record charts and analysis was done using SPSS-20. RESULTS 80 cases (1.6%) of CABM out of 4996 admissions were identified. There were 60 (75%) cases of CABM using WHO criteria of cerebrospinal fluid leukocytosis (CSF) > 100cells/mm3, or 10-100cells/mm3 with either hypoglycorrhea or increased protein; and 20 (25%) with culture confirmation. S. Pneumoniae was the most frequent pathogen identified in 14 (70%) children. The most common age group were infants 2-12 month old (n = 32, 40%). Children with adverse outcomes had shown a higher frequency of being older children (p = 0.045), loss of consciousness (p = 0.046), seizure at admission (p < 0.01), and a positive CSF culture (p = 0.03). CONCLUSION Introduction of PCV-10 has shown a decreased admission rate, mortality, and neurologic sequelae due to CABM.
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Affiliation(s)
- Ashenafi Tazebew Amare
- Department of Paediatrics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Zemene Tigabu Kebede
- Department of Paediatrics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Tadesse BT, Foster BA, Shibeshi MS, Dangiso HT. Empiric Treatment of Acute Meningitis Syndrome in a Resource-Limited Setting: Clinical Outcomes and Predictors of Survival or Death. Ethiop J Health Sci 2018; 27:581-588. [PMID: 29487467 PMCID: PMC5811937 DOI: 10.4314/ejhs.v27i6.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Bacterial meningitis is a significant cause of morbidity and mortality in the developing world. However, limited research has focused on the diagnosis and management of meningitis in resource-limited settings. Methods We designed a prospective case series of children admitted to a large, academic referral hospital with acute meningitis syndrome. Data were collected on age, time of presentation, prior antibiotics, cerebrospinal fluid (CSF) parameters, antibiotic and steroid prescription, and clinical outcome. Results Data on 99 patients were collected and analyzed. Most of the patients were males, n=69 (70%), and were from a rural area, n=83 (84%). Incomplete vaccination was common, n=36 (36%) and many have evidence of malnutrition, n=25 (38%). Most patients, n=64 (72%), had received antibiotics prior to admission with a mean duration of symptoms of 4.9 days prior to admission. The CSF white blood cell (WBC) count was higher in those who had not received prior antibiotics though it was elevated in both groups. The CSF WBC count was not associated with survival; malnutrition and length of symptoms prior to admission were both associated with decreased survival. Conclusions While use of antibiotics prior to obtaining CSF in patients with acute meningitis syndrome may decrease their CSF WBC count, it is not clinically significant. Many patients had a significant delay in presentation that had an effect on survival, This is a potentially modifiable risk factor despite the resourcelimited setting.
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Affiliation(s)
- Birkneh Tilahun Tadesse
- Department of Child Health, Hawassa University College of Health Sciences, Hawassa, Ethiopia
| | | | - Mulugeta Sitot Shibeshi
- Department of Child Health, Hawassa University College of Health Sciences, Hawassa, Ethiopia
| | - Henok Tadele Dangiso
- Department of Child Health, Hawassa University College of Health Sciences, Hawassa, Ethiopia
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Mioramalala SA, Ramasy Razafindratovo RM, Rakotozanany A, Miarimbola R, Weldegebriel G, Mwenda JM, Robinson AL. Analysis of Death and Survival Factors Associated with Childhood Bacterial Meningitis at a Reference Pediatric Hospital in Antananarivo, Madagascar. JOURNAL OF IMMUNOLOGICAL SCIENCES 2018; Suppl:8-14. [PMID: 30843000 PMCID: PMC6398577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Bacterial meningitis (BM) remains a global public health problem and most cases and deaths occur in Sub-Saharan Africa and especially in children less than five years old, due to a variety of factors. This study was conducted to determine the principal factors associated with death and survival of children due to BM in a typical African tertiary health facility. METHODS A retrospective case-control study of children hospitalized for BM was conducted in the University Hospital of Tsaralalàna (CHUMET). All children aged 3 to 59 months hospitalized for bacterial meningitis and confirmed by bacteriology were included. The cases were children who died from BM, and the controls were the survivors. Data was analyzed using Stata 13. RESULTS The factors associated with death were the number of siblings over 3 (14,48 [2,53 - 82,95]), overcrowding (9,31 [1,39 - 62,29]), time before hospitalization of more than five days (9,26 [1,36 - 62,92]), impaired consciousness (47,74 [6,24 - 364,96]), and meningococcal meningitis (36,68 [1,90 - 704,97]). CONCLUSION These factors are mainly indicators of low socioeconomic status, clinical severity of signs and particularly virulent organisms. The early detection of patients at risk allows clinicians to give them appropriate care right from admission. Further studies are necessary especially, the evaluation of the emergency care provided.
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Affiliation(s)
- Sedera Aurélien Mioramalala
- Public Health Department, Faculty of Médicine, Antananarivo, Madagascar,National Malaria Country Program, Public Health Ministry, Antananarivo, Madagascar,Correspondence: Dr. Sedera Aurélien Mioramalala, En face de l’ENAM, Androhibe – Antananarivo 101: National Malaria Country Program, Public Health Ministry, Antananarivo, Madagascar; Telephone No: +263772216853;
| | | | - Ando Rakotozanany
- Center Hospital Academic Mother Child, Public Health Ministry, Centre Hospitalier Universitaire Mère Enfant Tsaralalàna (CHU MET), Antananarivo, Madagascar
| | | | | | - Jason M Mwenda
- WHO Regional Office for Africa (WHO/AFRO), Brazzaville, Congo
| | - Annick Lalaina Robinson
- Mother and Child Department, Faculty of Medicine, Antananarivo, Madagascar,Center Hospital Academic Mother Child, Public Health Ministry, Centre Hospitalier Universitaire Mère Enfant Tsaralalàna (CHU MET), Antananarivo, Madagascar
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Goenka A, Jeena PM, Mlisana K, Solomon T, Spicer K, Stephenson R, Verma A, Dhada B, Griffiths MJ. Rapid Accurate Identification of Tuberculous Meningitis Among South African Children Using a Novel Clinical Decision Tool. Pediatr Infect Dis J 2018; 37:229-234. [PMID: 28777205 PMCID: PMC5747355 DOI: 10.1097/inf.0000000000001726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early diagnosis of tuberculous meningitis (TBM) is crucial to achieve optimum outcomes. There is no effective rapid diagnostic test for use in children. We aimed to develop a clinical decision tool to facilitate the early diagnosis of childhood TBM. METHODS Retrospective case-control study was performed across 7 hospitals in KwaZulu-Natal, South Africa (2010-2014). We identified the variables most predictive of microbiologically confirmed TBM in children (3 months to 15 years) by univariate analysis. These variables were modelled into a clinical decision tool and performance tested on an independent sample group. RESULTS Of 865 children with suspected TBM, 3% (25) were identified with microbiologically confirmed TBM. Clinical information was retrieved for 22 microbiologically confirmed cases of TBM and compared with 66 controls matched for age, ethnicity, sex and geographical origin. The 9 most predictive variables among the confirmed cases were used to develop a clinical decision tool (CHILD TB LP): altered Consciousness; caregiver HIV infected; Illness length >7 days; Lethargy; focal neurologic Deficit; failure to Thrive; Blood/serum sodium <132 mmol/L; CSF >10 Lymphocytes ×10/L; CSF Protein >0.65 g/L. This tool successfully classified an independent sample of 7 cases and 21 controls with a sensitivity of 100% and specificity of 90%. CONCLUSIONS The CHILD TB LP decision tool accurately classified microbiologically confirmed TBM. We propose that CHILD TB LP is prospectively evaluated as a novel rapid diagnostic tool for use in the initial evaluation of children with suspected neurologic infection presenting to hospitals in similar settings.
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Affiliation(s)
- Anu Goenka
- Manchester Collaborative Centre for Inflammation Research, University of Manchester, UK
- Manchester Academic Health Sciences Centre, University of Manchester, UK
- Department of Paediatrics and Child Health, Pietermaritzburg Metropolitan Hospitals Complex, South Africa
| | - Prakash M. Jeena
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, South Africa
| | - Koleka Mlisana
- Department of Microbiology, National Health Laboratory Service, South Africa
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, South Africa
| | - Tom Solomon
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, UK
- Walton Centre NHS Foundation Trust, UK
| | - Kevin Spicer
- Department of Paediatrics and Child Health, Pietermaritzburg Metropolitan Hospitals Complex, South Africa
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, South Africa
| | - Rebecca Stephenson
- Department of Paediatrics and Child Health, Pietermaritzburg Metropolitan Hospitals Complex, South Africa
| | - Arpana Verma
- Manchester Academic Health Sciences Centre, University of Manchester, UK
- Centre for Epidemiology, Institute of Population Health, University of Manchester, UK
| | - Barnesh Dhada
- Department of Paediatrics and Child Health, Pietermaritzburg Metropolitan Hospitals Complex, South Africa
- Department of Paediatrics and Child Health, University of KwaZulu-Natal, South Africa
| | - Michael J. Griffiths
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, UK
- Department of Neurology, Alder Hey Children’s NHS Trust, UK
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Wall ECB, Ajdukiewicz KMB, Bergman H, Heyderman RS, Garner P. Osmotic therapies added to antibiotics for acute bacterial meningitis. Cochrane Database Syst Rev 2018; 2:CD008806. [PMID: 29405037 PMCID: PMC5815491 DOI: 10.1002/14651858.cd008806.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Every day children and adults die from acute community-acquired bacterial meningitis, particularly in low-income countries, and survivors risk deafness, epilepsy and neurological disabilities. Osmotic therapies may attract extra-vascular fluid and reduce cerebral oedema, and thus reduce death and improve neurological outcomes.This is an update of a Cochrane Review first published in 2013. OBJECTIVES To evaluate the effects of osmotic therapies added to antibiotics for acute bacterial meningitis in children and adults on mortality, deafness and neurological disability. SEARCH METHODS We searched CENTRAL (2017, Issue 1), MEDLINE (1950 to 17 February 2017), Embase (1974 to 17 February 2017), CINAHL (1981 to 17 February 2017), LILACS (1982 to 17 February 2017) and registers of ongoing clinical trials (ClinicalTrials.com, WHO ICTRP) (21 February 2017). We also searched conference abstracts and contacted researchers in the field (up to 12 December 2015). SELECTION CRITERIA Randomised controlled trials testing any osmotic therapy in adults or children with acute bacterial meningitis. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results and selected trials for inclusion. Results are presented using risk ratios (RR) and 95% confidence intervals (CI) and grouped according to whether the participants received steroids or not. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included five trials with 1451 participants. Four trials evaluated glycerol against placebo, and one evaluated glycerol against 50% dextrose; in addition three trials evaluated dexamethasone and one trial evaluated acetaminophen (paracetamol) in a factorial design. Stratified analysis shows no effect modification with steroids; we present aggregate effect estimates.Compared to placebo, glycerol probably has little or no effect on death in people with bacterial meningitis (RR 1.08, 95% CI 0.90 to 1.30; 5 studies, 1272 participants; moderate-certainty evidence), but may reduce neurological disability (RR 0.73, 95% CI 0.53 to 1.00; 5 studies, 1270 participants; low-certainty evidence).Glycerol may have little or no effect on seizures during treatment for meningitis (RR 1.08, 95% CI 0.90 to 1.30; 4 studies, 1090 participants; low-certainty evidence).Glycerol may reduce the risk of subsequent deafness (RR 0.64, 95% CI 0.44 to 0.93; 5 studies, 922 participants; low to moderate-certainty evidence).Glycerol probably has little or no effect on gastrointestinal bleeding (RR 0.93, 95% CI 0.39 to 2.19; 3 studies, 607 participants; moderate-certainty evidence). The evidence on nausea, vomiting and diarrhoea is uncertain (RR 1.09, 95% CI 0.81 to 1.47; 2 studies, 851 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Glycerol was the only osmotic therapy evaluated, and data from trials to date have not demonstrated an effect on death. Glycerol may reduce neurological deficiency and deafness.
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Affiliation(s)
- Emma CB Wall
- University College LondonDivision of Infection and ImmunityGower StreetLondonUKWC1E 6BT
| | - Katherine MB Ajdukiewicz
- Pennine Acute Hospitals NHS TrustDepartment of Infectious DiseasesNorth Manchester General HospitalDelaunays Road, CrumpsallManchesterUKMB 5RB
| | - Hanna Bergman
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Robert S Heyderman
- University of Malawi College of MedicineMalawi‐Liverpool‐Wellcome Clinical Research ProgrammeP. O Box 30096BlantyreChichiriMalawi
| | - Paul Garner
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolMerseysideUKL3 5QA
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Jiang H, Su M, Kui L, Huang H, Qiu L, Li L, Ma J, Du T, Fan M, Sun Q, Liu X. Prevalence and antibiotic resistance profiles of cerebrospinal fluid pathogens in children with acute bacterial meningitis in Yunnan province, China, 2012-2015. PLoS One 2017; 12:e0180161. [PMID: 28662145 PMCID: PMC5491142 DOI: 10.1371/journal.pone.0180161] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 06/10/2017] [Indexed: 11/18/2022] Open
Abstract
Acute bacterial meningitis is still considered one of the most dangerous infectious diseases in children. To investigate the prevalence and antibiotic resistance profiles of cerebrospinal fluid (CSF) pathogens in children with acute bacterial meningitis in Southwest China, CSF samples from 179 meningitis patients (3 days to 12 years old) with positive culture results were collected from 2012 to 2015. Isolated pathogens were identified using the Vitek-32 system. Gram stain results were used to guide subcultures and susceptibility testing. The antimicrobial susceptibility of isolates was determined using the disc diffusion method. Of the isolates, 50.8% were Gram-positive bacteria, and 49.2% were Gram-negative bacteria. The most prevalent pathogens were E. coli (28.5%), Streptococcus pneumoniae (17.8%), Staphylococcus epidermidis (10.0%), Haemophilus influenzae type b (9.5%), and group B streptococcus (7.2%). In young infants aged ≤3 months, E. coli was the organism most frequently isolated from CSF (39/76; 51.3%), followed by group B streptococcus (13/76; 17.1%) and Streptococcus pneumoniae (8/76; 10.5%). However, in young infants aged >3 months, the most frequently isolated organism was Streptococcus pneumoniae (24/103; 23.3%), followed by Staphylococcus epidermidis (18/103; 17.5%) and Haemophilus influenzae type b (16/103; 15.5%). Antimicrobial susceptibility tests indicated that for E. coli isolates, the susceptibility rates to aminoglycosides ranged from 56.8% to 100.0%, among them, amikacin was identified as the most effective against E. coli. As for cephalosporins, the susceptibility rates ranged from 29.4% to 78.4%, and cefoxitin was identified as the most effective cephalosporin. In addition, the susceptibility rates of piperacillin/tazobactam and imipenem against E. coli were 86.3% and 100%. Meanwhile, the susceptibility rates of Streptococcus pneumoniae isolates to penicillin G, erythromycin, chloramphenicol, ceftriaxone and tetracycline were 68.8%, 0.0%, 87.5%, 81.3% and 0.0%, respectively. Gentamycin, ofloxacin, linezolid and vancomycin were identified as the most effective antibiotics for Streptococcus pneumoniae, each with susceptibility rates of 100%. It was notable that other emerging pathogens, such as Listeria monocytogenes and group D streptococcus, cannot be underestimated in meningitis.
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Affiliation(s)
- Hongchao Jiang
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China.,Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, P.R. China
| | - Min Su
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Liyue Kui
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Hailin Huang
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Lijuan Qiu
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China.,Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, P.R. China
| | - Li Li
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Jing Ma
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Tingyi Du
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Mao Fan
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
| | - Qiangming Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, P.R. China.,Yunnan Key Laboratory of Vaccine Research & Development on Severe Infectious Diseases, Kunming, PR China
| | - Xiaomei Liu
- The Affiliated Children's Hospital of Kunming Medical University, Kunming, P.R. China
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Pediatric bacterial meningitis in Japan, 2013-2015 - 3-5 years after the wide use of Haemophilus influenzae type b and Streptococcus pneumoniae conjugated vaccines. J Infect Chemother 2017; 23:427-438. [PMID: 28456490 DOI: 10.1016/j.jiac.2017.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/22/2017] [Accepted: 02/28/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Haemophilus influenzae type b (Hib) vaccine and pneumococcal conjugated vaccine (PCV) have been widely used since 2010 in Japan when both vaccines were supported by the regional governments, and they were covered as routine recommended vaccines in 2013. The incidence of bacterial meningitis due to these organisms decreased in 2011 and 2012, but meningitis due to Streptococcus agalactiae and Escherichia coli remained unchanged. OBJECTIVES We planned to confirm whether the incidence also decreased in subsequent years. METHODS We analyzed the epidemiological and clinical data for 2013-2015, and compared the information obtained in the previous nationwide survey database and our previous reports. We also investigated the risk factors for disease outcome. RESULTS In the 2013-2015 surveys, 407 patients from 366 hospitals from all prefectures were evaluated. S. agalactiae (33%), Streptococcus pneumoniae (25%), and E. coli (10%) were the main organisms. The total number of patients hospitalized with bacterial meningitis per 1000 admissions decreased from 1.19 in 2009-2010 to 0.37 in 2013-2015 (p < 0.001). The incidence of H. influenzae and S. pneumoniae meningitis significantly decreased from 0.66 in 2009-2010 to 0.01 in 2013-2015, and from 0.30 to 0.09, respectively (p < 0.001). Only 0-2 cases with Neisseria meningitidis were reported each year throughout 2001-2015. The fatality rates for H. influenzae, S. pneumoniae, S. agalactiae, and E. coli in 2013-2015 were 0.0, 4.1, 3.1, and 2.6%, respectively. Risk factors for death and sequelae were consciousness disturbance, convulsion, low CSF glucose, and Staphylococcus sp. as a causative organism (p < 0.01). CONCLUSIONS Hib vaccine and PCV have decreased the rate of bacterial meningitis. S. agalactiae has subsequently become the most common cause of bacterial meningitis in Japan.
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Keddy KH, Sooka A, Musekiwa A, Smith AM, Ismail H, Tau NP, Crowther-Gibson P, Angulo FJ, Klugman KP. Clinical and Microbiological Features of Salmonella Meningitis in a South African Population, 2003-2013. Clin Infect Dis 2016; 61 Suppl 4:S272-82. [PMID: 26449942 DOI: 10.1093/cid/civ685] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The clinical and microbiological characteristics of nontyphoidal Salmonella (NTS) meningitis in South Africa, where human immunodeficiency virus (HIV) prevalence is high (approximately 15% in persons ≥15 years of age), were reviewed. METHODS From 2003 through 2013, 278 cases were identified through national laboratory-based surveillance. Clinical information (age, sex, outcome, Glasgow Coma Scale [GCS], and HIV status) was ascertained at selected sites. Isolates were serotyped; susceptibility testing and multilocus sequence typing on Salmonella enterica serovar Typhimurium isolates was performed. Multivariable logistic regression was used to determine factors associated with mortality outcome, using Stata software, version 13. RESULTS Where age was ascertained, 139 of 256 (54.3%) patients were <15 years. Males represented 151 of 267 (56.6%). Mortality outcome was recorded for 112 of 146 (76.7%) enhanced surveillance patients; 53 of 112 (47.3%) died. Death was associated with GCS ≤13 (adjusted odds ratio [OR], 18.7; 95% confidence interval [CI], 3.0-118.5; P = .002) on multivariable analysis. Where data were available, all 45 patients aged >15 years were HIV infected, compared with 24 of 46 (52.2%) patients aged <5 years. Neonates were less likely to be HIV infected than infants aged 2-12 months (OR, 4.8; 95% CI, 1.1-21.1; P = .039).Salmonella Typhimurium represented 106 of 238 (44.5%) serotyped isolates: 65 of 95 (68.4%) were ST313 vs ST19, respectively, and significantly associated with HIV-infected patients (P = .03) and multidrug resistance (OR, 6.6; 95% CI, 2.5-17.2; P < .001). CONCLUSIONS NTS meningitis in South Africa is highly associated with HIV in adults, with neonates (irrespective of HIV status), and with Salmonella Typhimurium ST313. GCS is the best predictor of mortality: early diagnosis and treatment are critical. Focused prevention requires further studies to understand the sources and transmission routes.
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Affiliation(s)
- Karen H Keddy
- Centre for Enteric Diseases, National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Arvinda Sooka
- Centre for Enteric Diseases, National Institute for Communicable Diseases
| | - Alfred Musekiwa
- International Emerging Infections Programme, South Africa Global Disease Detection Centre, Centers for Disease Control and Prevention, Pretoria
| | - Anthony M Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Husna Ismail
- Centre for Enteric Diseases, National Institute for Communicable Diseases
| | - Nomsa P Tau
- Centre for Enteric Diseases, National Institute for Communicable Diseases
| | - Penny Crowther-Gibson
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Frederick J Angulo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention
| | - Keith P Klugman
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg Hubert Department of Global Health, Rollins School of Public Health, and Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
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Mallewa M, Vallely P, Faragher B, Banda D, Klapper P, Mukaka M, Khofi H, Pensulo P, Taylor T, Molyneux M, Solomon T. Viral CNS infections in children from a malaria-endemic area of Malawi: a prospective cohort study. LANCET GLOBAL HEALTH 2015; 1:e153-60. [PMID: 24748325 PMCID: PMC3986031 DOI: 10.1016/s2214-109x(13)70060-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Fever with reduced consciousness is an important cause of hospital admission of children in sub-Saharan Africa, with high mortality. Cerebral malaria, diagnosed when acute Plasmodium falciparum infection and coma are recorded with no other apparent reason, is one important cause. We investigated whether viruses could also be an important cause of CNS infection in such patients, and examined the relative contribution of viral pathogens and malaria parasitaemia. Methods We did a prospective cohort study in Blantyre, Malawi. From March 1, 2002, to Aug 31, 2004, we enrolled children aged between 2 months and 15 years who were admitted to hospital with suspected non-bacterial CNS infections. Children with a cerebrospinal fluid (CSF) white cell count of less than 1000 cells per μL and negative bacterial microscopy and culture were deemed to have suspected viral CNS infection. Blood was examined for asexual forms of P falciparum. PCR was done on CSF or on post-mortem brain biopsy specimens to detect 15 viruses known to cause CNS infection. Findings Full outcome data were available for 513 children with suspected viral CNS infection, of whom 94 (18%) died. 163 children (32%) had P falciparum parasitaemia, of whom 34 (21%) died. At least one virus was detected in the CNS in 133 children (26%), of whom 43 (33%) died. 12 different viruses were detected; adenovirus was the most common, affecting 42 children; mumps, human herpes virus 6, rabies, cytomegalovirus, herpes simplex virus 1, and enterovirus were also important. 45 (9%) of the 513 children had both parasitaemia and viral infection, including 27 (35%) of 78 diagnosed clinically with cerebral malaria. Children with dual infection were more likely to have seizures than were those with parasitaemia alone, viral infection only, or neither (p<0·0001). 17 (38%) of the 45 children with dual infection died, compared with 26 (30%) of 88 with viral infection only, 17 (14%) of 118 with parasitaemia only, and 34 (13%) of 262 with neither (p<0·0001). Logistic regression showed children with a viral CNS infection had a significantly higher mortality than did those who did not have a viral CNS infection (p=0·001). Interpretation Viral CNS infections are an important cause of hospital admission and death in children in Malawi, including in children whose coma might be attributed solely to cerebral malaria. Interaction between viral infection and parasitaemia could increase disease severity. Funding Wellcome Trust, US National Institutes of Health, and UK Medical Research Council.
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Abstract
BACKGROUND Acute bacterial meningitis (ABM) remains a significant cause of pediatric illness and death in low and middle income countries. Identifying severity risk factors and predictive scores may guide interventions to reduce poor outcomes. METHODS Data from a prospective surveillance study for ABM in children aged 0-59 months admitted to 3 referral hospitals in Guatemala City from 2000 to 2007 were analyzed. ABM was defined as positive cerebrospinal fluid (CSF) culture, positive latex agglutination or CSF white blood cell greater than 100 cells/mL. Univariate and multivariate analyses of risk factors at hospital admission that predicted major morbidity or death during hospitalization were performed, along with validation of the predictive Herson-Todd score (HTS). RESULTS Of 809 children with ABM episodes, 221 (27.3%) survived with major morbidity and 192 (23.7%) died. Among 383 children with nonmissing data, the most significant multivariate predictors for death or major morbidity were seizure [odds ratio (OR), 101.5; P < 0.001], CSF glucose less than 20 mg/dL (OR, 5.3; P = 0.0004), symptom duration more than 3 days (OR, 3.7; P = 0.003) and coma (OR, 6.3; P = 0.004). Of 221 children with a HTS greater than 5, 204 (92%) died or suffered major morbidity (OR, 10.3; P < 0.0001). CONCLUSION ABM is a cause of considerable morbidity and mortality in Guatemala. Several clinical risk factors and the composite HTS predicted death or major morbidity. These predictors could help clinicians in low and middle income country guide medical care for ABM and could contribute to the public health impact assessment in preventing meningitis with vaccines.
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Update on the key developments of the neurologic complications in children infected with HIV. Curr Opin HIV AIDS 2015; 9:533-8. [PMID: 25188807 DOI: 10.1097/coh.0000000000000101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To discuss recent research findings of neurologic complications in HIV-infected children, specifically addressing neuroinfections, cerebrovascular disease, epilepsy and neurocognitive complications. The range of neurologic childhood onset complications is diverse and often overlaps diseases previously considered only to manifest in adults. In the pediatric population, these complications frequently have their own unique disease identity, which may be related to maturational patterns evident in the developing brain. RECENT FINDINGS Developments regarding the pathogenesis of neuroAIDS, treatment of tuberculous meningitis and prevention of bacterial meningitis are described. With the advent of neuroimaging, there is greater insight into silent cerebrovascular events and the progression of vasculopathy in HIV-infected children. The role of surgical intervention for affected cases is a novel area that could alter the otherwise poor prognosis. Epilepsy, although common as a burden of disease, carries its own additional complications with regard to cross reactivity with various antiretroviral therapies. Increased risk of low bone mineral density supports a role for supplementation with vitamin D in people receiving antiretroviral therapy and antiepileptic drugs. Recognition of the early neurobiological, as well as spectrum of neurocognitive effects of the HIV on the developing brain, is evolving, as greater numbers of children are treated early. Developments in these critical areas are described. SUMMARY Recent research reflects the need for improved strategies to prevent neuroinfections, more effective screening and interventions for vasculopathy and better antiepileptic drugs for HIV-infected children. Furthermore, our understanding of the timing and spectrum of neurocognitive complications is evolving.
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Zhang K, Dupont A, Torow N, Gohde F, Leschner S, Lienenklaus S, Weiss S, Brinkmann MM, Kühnel M, Hensel M, Fulde M, Hornef MW. Age-dependent enterocyte invasion and microcolony formation by Salmonella. PLoS Pathog 2014; 10:e1004385. [PMID: 25210785 PMCID: PMC4161480 DOI: 10.1371/journal.ppat.1004385] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/05/2014] [Indexed: 12/13/2022] Open
Abstract
The coordinated action of a variety of virulence factors allows Salmonella enterica to invade epithelial cells and penetrate the mucosal barrier. The influence of the age-dependent maturation of the mucosal barrier for microbial pathogenesis has not been investigated. Here, we analyzed Salmonella infection of neonate mice after oral administration. In contrast to the situation in adult animals, we observed spontaneous colonization, massive invasion of enteroabsorptive cells, intraepithelial proliferation and the formation of large intraepithelial microcolonies. Mucosal translocation was dependent on enterocyte invasion in neonates in the absence of microfold (M) cells. It further resulted in potent innate immune stimulation in the absence of pronounced neutrophil-dominated pathology. Our results identify factors of age-dependent host susceptibility and provide important insight in the early steps of Salmonella infection in vivo. We also present a new small animal model amenable to genetic manipulation of the host for the analysis of the Salmonella enterocyte interaction in vivo. Non-typhoidal Salmonella are among of the most prevalent causative agents of infectious diarrheal disease worldwide but also very significantly contribute to infant sepsis and meningitis particularly in developing countries. The underlying mechanisms of the elevated susceptibility of the infant host to systemic Salmonella infection have not been investigated. Here we analyzed age-dependent differences in the colonization, mucosal translocation and systemic spread in a murine oral infection model. We observed efficient entry of Salmonella in intestinal epithelial cells of newborn mice. Enterocyte invasion was followed by massive bacterial proliferation and the formation of large intraepithelial bacterial colonies. Intraepithelial, but not non-invasive, extracellular Salmonella induced a potent immune stimulation. Also, enterocyte invasion was required for translocation through the mucosal barrier and spread of Salmonella to systemic organs. This requirement was due to the absence of M cells, specialized epithelial cells that forward luminal antigen to the underlying immune cells, in the neonate host. Our results identify age-dependent factors of host susceptibility and illustrate the initial phase of Salmonella infection. They further present a new small animal model amenable to genetic manipulation to investigate the interaction of this pathogen with epithelial cells and characterize the early steps in Salmonella pathogenesis.
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Affiliation(s)
- Kaiyi Zhang
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Aline Dupont
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Natalia Torow
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Fredrik Gohde
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Sara Leschner
- Department of Molecular Immunology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Stefan Lienenklaus
- Department of Molecular Immunology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Siegfried Weiss
- Department of Molecular Immunology, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Melanie M. Brinkmann
- Department of Viral Immune Modulation, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany
| | - Mark Kühnel
- Centre for Anatomy, Hannover Medical School, Hannover, Germany
| | - Michael Hensel
- Division of Microbiology, University of Osnabrück, Osnabrück, Germany
| | - Marcus Fulde
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
- * E-mail: (MF); (MWH)
| | - Mathias W. Hornef
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
- * E-mail: (MF); (MWH)
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Wall EC, Everett DB, Mukaka M, Bar-Zeev N, Feasey N, Jahn A, Moore M, van Oosterhout JJ, Pensalo P, Baguimira K, Gordon SB, Molyneux EM, Carrol ED, French N, Molyneux ME, Heyderman RS. Bacterial meningitis in Malawian adults, adolescents, and children during the era of antiretroviral scale-up and Haemophilus influenzae type b vaccination, 2000-2012. Clin Infect Dis 2014; 58:e137-45. [PMID: 24496208 PMCID: PMC4001285 DOI: 10.1093/cid/ciu057] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/18/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We documented bacterial meningitis trends among adults and children presenting to a large teaching hospital in Malawi during introduction of Haemophilus influenzae type b (Hib) vaccination and the rollout of antiretroviral therapy (ART). METHODS We analyzed data from 51 000 consecutive cerebrospinal fluid (CSF) samples obtained from adults, adolescents, and children with suspected meningitis admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi, between 2000 and 2012. RESULTS There was a significant decline in the total number of CSF isolates over 12 years (incident rate ratio [IRR], 0.93; 95% CI, .92-.94; P < .001). This decline was entirely in children aged <5 years (IRR, 0.87; 95% CI, .85-.88; P < .001) and coincided with the introduction of Hib vaccination. The number of adult isolates has remained unchanged (IRR, 0.99; 95% CI, .97-1.0; P = .135) despite rapid scale-up of ART provision. In children aged <5 years, Streptococcus pneumoniae, nontyphoidal salmonellae (NTS), and Hib were the most frequently isolated pathogens, and have declined over this time period. Streptococcus pneumoniae was the most frequently isolated pathogen in older children and adults. Estimated incidence of bacterial meningitis in 2012 was 20 per 100,000 cases in children aged <14 years, 6 per 100,000 adolescents, and 10 per 100,000 adults. CONCLUSIONS Rates of bacterial meningitis have declined in children, but not adults, coinciding with the introduction of Hib vaccination. The highly successful rollout of ART has not yet resulted in a reduction in the incidence in adults where the burden remains high. Long-term surveillance of bacterial meningitis outside of the epidemic "meningitis belt" in Africa is essential.
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MESH Headings
- Adolescent
- Adult
- Antiretroviral Therapy, Highly Active
- Bacterial Capsules
- Cerebrospinal Fluid/microbiology
- Child
- Child, Preschool
- Drug Utilization
- HIV Infections/complications
- HIV Infections/epidemiology
- Haemophilus Vaccines
- Haemophilus influenzae type b/isolation & purification
- Humans
- Incidence
- Infant
- Malawi/epidemiology
- Meningitis, Bacterial/cerebrospinal fluid
- Meningitis, Bacterial/complications
- Meningitis, Bacterial/epidemiology
- Meningitis, Bacterial/microbiology
- Meningitis, Haemophilus/complications
- Meningitis, Haemophilus/epidemiology
- Meningitis, Haemophilus/microbiology
- Meningitis, Meningococcal/complications
- Meningitis, Meningococcal/epidemiology
- Meningitis, Pneumococcal/complications
- Meningitis, Pneumococcal/epidemiology
- Meningitis, Pneumococcal/microbiology
- Streptococcus pneumoniae/isolation & purification
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Affiliation(s)
- Emma C Wall
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
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Lin MC, Chiu NC, Chi H, Ho CS, Huang FY. Evolving trends of neonatal and childhood bacterial meningitis in northern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 48:296-301. [PMID: 24184002 DOI: 10.1016/j.jmii.2013.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 08/08/2013] [Accepted: 08/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The epidemiology of bacterial meningitis varies in different areas, age groups, and times. To know the trend of neonatal and childhood bacterial meningitis in northern Taiwan, we performed this 29-year-long assessment. METHODS Eligible patients were aged 18 years or younger, hospitalized in Mackay Memorial Hospital between 1984 and 2012, and proven by positive cerebrospinal fluid bacterial cultures. Analysis included the patient numbers and pathogens in different age groups, periods, complications, and outcomes. RESULTS Males were predominant in all the age groups through the years. Almost half of the patients were in the neonatal period. Patient numbers went up in the early study period and declined after 1993-1997. Group B Streptococcus and Escherichia coli were the most common pathogens in neonates, whereas in childhood were Streptococcus pneumoniae and Haemophilus influenzae type b (Hib). Patient numbers of Group B Streptococcus, S. pneumoniae, and Hib meningitis declined in the late study period, but E. coli meningitis increased. The mortality rate decreased but sequela rate increased. Among the four most common pathogens, S. pneumoniae had the worst outcome and had highest mortality rate. All Hib meningitis patients survived, but their sequela rate was the highest. CONCLUSION This study provides an epidemiological data on trends of neonatal and childhood bacterial meningitis in northern Taiwan during the past 29 years, including male and neonatal predominance, decrease of total patient number in recent years, change of major pathogens, and declined mortality but raised morbidity.
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Affiliation(s)
- Meng-Chin Lin
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Nan-Chang Chiu
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing, and Management College, Taipei, Taiwan.
| | - Hsin Chi
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing, and Management College, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Che-Sheng Ho
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
| | - Fu-Yuan Huang
- Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan
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Wall EC, Cartwright K, Scarborough M, Ajdukiewicz KM, Goodson P, Mwambene J, Zijlstra EE, Gordon SB, French N, Faragher B, Heyderman RS, Lalloo DG. High mortality amongst adolescents and adults with bacterial meningitis in sub-Saharan Africa: an analysis of 715 cases from Malawi. PLoS One 2013; 8:e69783. [PMID: 23894538 PMCID: PMC3716691 DOI: 10.1371/journal.pone.0069783] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 06/13/2013] [Indexed: 01/09/2023] Open
Abstract
Mortality from bacterial meningitis in African adults is significantly higher than those in better resourced settings and adjunctive therapeutic interventions such as dexamethasone and glycerol have been shown to be ineffective. We conducted a study analysing data from clinical trials of bacterial meningitis in Blantyre, Malawi to investigate the clinical parameters associated with this high mortality. Methods We searched for all clinical trials undertaken in Blantyre investigating bacterial meningitis from 1990 to the current time and combined the data from all included trial datasets into one database. We used logistic regression to relate individual clinical parameters to mortality. Adults with community acquired bacterial meningitis were included if the CSF culture isolate was consistent with meningitis or if the CSF white cell count was >100 cells/mm3 (>50% neutrophils) in HIV negative participants and >5 cells/mm3 in HIV positive participants. Outcome was measured by mortality at discharge from hospital (after 10 days of antibiotic therapy) and community follow up (day 40). Results Seven hundred and fifteen episodes of bacterial meningitis were evaluated. The mortality rate was 45% at day 10 and 54% at day 40. The most common pathogens were S.pneumoniae (84% of positive CSF isolates) and N.meningitidis (4%). 607/694 (87%) participants tested were HIV antibody positive. Treatment delays within the hospital system were marked. The median presenting GCS was 12/15, 17% had GCS<8 and 44.9% had a seizure during the illness. Coma, seizures, tachycardia and anaemia were all significantly associated with mortality on multivariate analysis. HIV status and pneumococcal culture positivity in the CSF were not associated with mortality. Adults with community acquired bacterial meningitis in Malawi present with a severe clinical phenotype. Predictors of high mortality are different to those seen in Western settings. Optimising in-hospital care and minimising treatment delays presents an opportunity to improve outcomes considerably.
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Affiliation(s)
- Emma C Wall
- Clinical group, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
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Hudson LD, Viner RM, Christie D. Long-Term Sequelae of Childhood Bacterial Meningitis. Curr Infect Dis Rep 2013; 15:236-41. [DOI: 10.1007/s11908-013-0332-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Wall ECB, Ajdukiewicz KMB, Heyderman RS, Garner P. Osmotic therapies added to antibiotics for acute bacterial meningitis. Cochrane Database Syst Rev 2013; 3:CD008806. [PMID: 23543568 PMCID: PMC3996551 DOI: 10.1002/14651858.cd008806.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Every day children and adults throughout the world die from acute community-acquired bacterial meningitis, particularly in low-income countries. Survivors are at risk of deafness, epilepsy and neurological disabilities. Osmotic therapies have been proposed as an adjunct to improve mortality and morbidity from bacterial meningitis. The theory is that they will attract extra-vascular fluid by osmosis and thus reduce cerebral oedema by moving excess water from the brain into the blood. The intention is to thus reduce death and improve neurological outcomes. OBJECTIVES To evaluate the effects on mortality, deafness and neurological disability of osmotic therapies added to antibiotics for acute bacterial meningitis in children and adults. SEARCH METHODS We searched CENTRAL 2012, Issue 11, MEDLINE (1950 to November week 3, 2012), EMBASE (1974 to November 2012), CINAHL (1981 to November 2012), LILACS (1982 to November 2012) and registers of ongoing clinical trials (April 2012). We also searched conference abstracts and contacted researchers in the field. SELECTION CRITERIA Randomised controlled trials testing any osmotic therapy in adults or children with acute bacterial meningitis. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results and selected trials for inclusion. We collected data from each study for mortality, deafness, seizures and neurological disabilities. Results are presented using risk ratios (RR) and 95% confidence intervals (CI) and grouped according to whether the participants received steroids or not. MAIN RESULTS Four trials were included comprising 1091 participants. All compared glycerol (a water-soluble sugar alcohol) with a control; in three trials this was a placebo, and in one a small amount of 50% dextrose. Three trials included comparators of dexamethasone alone or in combination with glycerol. As dexamethasone appeared to have no modifying effect, we aggregated results across arms where both treatment and control groups received corticosteroids and where both treatment and control groups did not.Compared to placebo, glycerol may have little or no effect on death in people with bacterial meningitis (RR 1.09, 95% confidence interval (CI) 0.89 to 1.33, 1091 participants, four trials, low-quality evidence); or on death and neurological disability combined (RR 1.04, 95% CI 0.86 to 1.25).Glycerol may have little or no effect on seizures during treatment for meningitis (RR 1.08, 95% CI 0.90 to 1.30, 909 participants, three trials, low-quality evidence).Glycerol may reduce the risk of subsequent deafness (RR 0.60, 95% CI 0.38 to 0.93, 741 participants, four trials, low-quality evidence). AUTHORS' CONCLUSIONS The only osmotic diuretic to have undergone randomised evaluation is glycerol. Data from trials to date have not demonstrated benefit on death, but it may reduce deafness. Osmotic diuretics, including glycerol, should not be given to adults and children with bacterial meningitis unless as part of carefully conducted randomised controlled trial.
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Affiliation(s)
- Emma C B Wall
- International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.
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