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van Ettekoven CN, Liechti FD, Brouwer MC, Bijlsma MW, van de Beek D. Global Case Fatality of Bacterial Meningitis During an 80-Year Period: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e2424802. [PMID: 39093565 PMCID: PMC11297475 DOI: 10.1001/jamanetworkopen.2024.24802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/16/2024] [Indexed: 08/04/2024] Open
Abstract
Importance The impact of vaccination, antibiotics, and anti-inflammatory treatment on pathogen distribution and outcome of bacterial meningitis over the past century is uncertain. Objective To describe worldwide pathogen distribution and case fatality ratios of community-acquired bacterial meningitis. Data Sources Google Scholar and MEDLINE were searched in January 2022 using the search terms bacterial meningitis and mortality. Study Selection Included studies reported at least 10 patients with bacterial meningitis and survival status. Studies that selected participants by a specific risk factor, had a mean observation period before 1940, or had more than 10% of patients with health care-associated meningitis, tuberculous meningitis, or missing outcome were excluded. Data Extraction and Synthesis Data were extracted by 1 author and verified by a second author. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Random-effects models stratified by age (ie, neonates, children, adults), Human Development Index (ie, low-income or high-income countries), and decade and meta-regression using the study period's year as an estimator variable were used. Main Outcome and Measure Case fatality ratios of bacterial meningitis. Results This review included 371 studies performed in 108 countries from January 1, 1935, to December 31, 2019, describing 157 656 episodes. Of the 33 295 episodes for which the patients' sex was reported, 13 452 (40%) occurred in females. Causative pathogens were reported in 104 598 episodes with Neisseria meningitidis in 26 344 (25%) episodes, Streptococcus pneumoniae in 26 035 (25%) episodes, Haemophilus influenzae in 22 722 (22%), other bacteria in 19 161 (18%) episodes, and unidentified pathogen in 10 336 (10%) episodes. The overall case fatality ratio was 18% (95% CI, 16%-19%), decreasing from 32% (95% CI, 24%-40%) before 1961 to 15% (95% CI, 12%-19%) after 2010. It was highest in meningitis caused by Listeria monocytogenes at 27% (95% CI, 24%-31%) and pneumococci at 24% (95% CI, 22%-26%), compared with meningitis caused by meningococci at 9% (95% CI, 8%-10%) or H influenzae at 11% (95% CI, 10%-13%). Meta-regression showed decreasing case fatality ratios overall and stratified by S pneumoniae, Escherichia coli, or Streptococcus agalactiae (P < .001). Conclusions and Relevance In this meta-analysis with meta-regression, declining case fatality ratios of community-acquired bacterial meningitis throughout the last century were observed, but a high burden of disease remained.
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Affiliation(s)
- Cornelis N. van Ettekoven
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurology, HagaZiekenhuis, The Hague, the Netherlands
| | - Fabian D. Liechti
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthijs C. Brouwer
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Merijn W. Bijlsma
- Department of Pediatrics, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Intusoma U, Thewamit R, Thamcharoenvipas T, Khantee P. Epidemiology and burden of Haemophilus influenzae disease in Thai children before implementation of the routine immunisation programme: A National Health Data Analysis. Trop Med Int Health 2022; 27:546-552. [PMID: 35477947 DOI: 10.1111/tmi.13755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To conduct the first pre-Haemophilus influenzae (Hi) type b (Hib) immunisation programme-based epidemiological study using national health data. METHODS We analysed National Health Security Office data, which cover 72% of the Thai population. The study population included children aged <18 years admitted for Hi disease from 2015 to 2019. Hi disease diagnosis and death were based on the International Statistical Classification of Diseases and Related Health Problems (10th revision) hospital discharge summary codes. We estimated the hospital cost per admission using diagnosis-related grouping with a global budget. RESULTS A total of 1125 children aged <18 years were admitted for Hi disease. During the 5-year-study, the annual incidence of Hi disease varied from 1.5 to 1.9 per 100,000 children, with an overall case fatality rate (CFR) of 2%. Pneumonia was the most common clinical form, followed by meningitis and sepsis. The incidence, clinical forms and severity of Hi disease were age specific. Infant CFR was higher than that of other age groups. The incidence of Hi disease in children aged <5 years was 4.9 per 100,000 (CFR = 2.0%). Sepsis was the primary cause of infant death, whereas pneumonia was the cause of death in children aged >5 years. The hospital cost ranged from 25,000 to 30,000 THB per admission. CONCLUSIONS This analysis provided epidemiological data of Hi in Thai children before the Hib routine immunisation programme. The incidence of Hi disease was lower than that previously speculated. Our results could facilitate an assessment of the impact of Hib immunisation programme in Thailand.
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Affiliation(s)
- Utcharee Intusoma
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Rapeepat Thewamit
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Titaporn Thamcharoenvipas
- Division of Neurology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Puttichart Khantee
- Division of Infectious Disease, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Global morbidity and mortality of central nervous system tuberculosis: a systematic review and meta-analysis. J Neurol 2022; 269:3482-3494. [PMID: 35288778 PMCID: PMC8920747 DOI: 10.1007/s00415-022-11052-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/02/2022]
Abstract
Background Tuberculosis (TB) is the second most common cause of death due to a single infectious agent worldwide after COVID-19. Up to 15% of the cases are extrapulmonary, and if it is located in the central nervous system (CNS-TB), it presents high morbidity and mortality. Still, the global epidemiology of CNS-TB remains unknown. Aim To estimate the global prevalence and incidence of CNS-TB based on the available literature. Methods We systematically searched in MEDLINE, Cochrane Central, Scopus, and LILACS databases (April 2020) and included observational studies evaluating the epidemiology of CNS-TB. Two independent researchers selected and assessed the quality of the studies and extracted relevant data. We performed random-effects model meta-analysis of proportions to estimate the pooled prevalence. The protocol of this study was registered in PROSPERO (CRD 42018103946). Results We included 53 studies from 28 countries, representing 12,621 patients with CNS-TB. The prevalence of CNS-TB was 2 per 100,000 inhabitants. According to the clinical setting, the prevalence of CNS-TB represented the 13.91% of all cases of meningitis and 4.55% of all cases of TB. The mortality was calculated by tuberculous meningitis due to the lack of data of other presentation, and it rose up to 42.12% in hospitalized patients. The burden of countries’ TB, Human Development Index (HDI), and the prevalence of HIV were the most important prevalence moderators, especially in patients with TB. No data on incidence were found. Conclusion The prevalence and mortality of CNS-TB remain high, and TB meningitis is the most frequent presentation. The highest prevalence was reported in developing countries, and its main moderators were the countries’ HDI and HIV infection. Our study was limited by high heterogeneity, risk of bias, and potential data under registration from developing countries. The integration of CNS-TB early detection and management into national TB programs and population-based studies from developing countries are needed for better global estimation and response. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11052-8.
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Wong CH, Duque JSR, Wong JSC, Chan CMV, Lam ICS, Fu YM, Cheong KN, Chua GT, Lee PP, Ip P, Ho MHK, Wong ICK, Chan GCF, Leung WH, Lee SL, Lee KP, Chiu SC, Wong MSR, Wong MSC, Lau YL, Kwan MYW. Epidemiology and Trends of Infective Meningitis in Neonates and Infants Less than 3 Months of Age in Hong Kong. Int J Infect Dis 2021; 111:288-294. [PMID: 34217874 DOI: 10.1016/j.ijid.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION AND AIMS Meningitis in neonates and young infants leads to significant morbidity and mortality worldwide. This study aims to investigate pathogens, antibiotics resistance and secular change of incidence in Hong Kong. METHODS We performed a retrospective search on meningitis in neonates and infants <3 months old in three Hong Kong public hospitals from 2004 to 2019. Medical charts were reviewed, focusing on the identification and antibiotics resistance of the pathogens. RESULTS 200 cases of meningitis were identified (67% were bacterial). Group B Streptococcus (GBS) and Escherichia coli (E. coli) were the commonest bacterial pathogens. The annual rates of early-onset GBS meningitis decreased since the implementation of the universal GBS screening and intrapartum antibiotics prophylaxis (IAP) in 2012, while that of late-onset GBS meningitis remained similar. A significant portion of E. coli isolates were resistant to ampicillin and/or gentamicin. CONCLUSION GBS and E. coli remained the commonest bacteria for meningitis in this age group. The annual rate of bacterial meningitis in Hong Kong declined in recent years, which was attributed by the decline in that of early-onset GBS meningitis due to the universal GBS screening and IAP. Antimicrobial-resistant bacterial strains that caused meningitis require further clinical and public health attention.
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Affiliation(s)
- Chi Hang Wong
- Department of Paediatric and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region, China
| | - Jaime S Rosa Duque
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Joshua Sung Chih Wong
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Chi-Man Victor Chan
- Department of Paediatric and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region, China
| | - Ivan Cheuk San Lam
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Yu Ming Fu
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Kai-Ning Cheong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Gilbert T Chua
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Pamela P Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Marco Hok Kung Ho
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ian Chi Kei Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Godfrey Chi-Fung Chan
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Wing Hang Leung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - So Lun Lee
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok Piu Lee
- Department of Paediatric and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong Special Administrative Region, China
| | - Shek Chi Chiu
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong Special Administrative Region, China
| | - Ming Sum Rosanna Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China
| | - Mabel Siu Chun Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yu-Lung Lau
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Hong Kong Children's Hospital, Hong Kong Special Administrative Region, China.
| | - Mike Yat-Wah Kwan
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong Special Administrative Region, China.
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Rizvi SMD, Hussain T, Ahmed ABF, Alshammari TM, Moin A, Ahmed MQ, Barreto GE, Kamal MA, Ashraf GM. Gold nanoparticles: A plausible tool to combat neurological bacterial infections in humans. Biomed Pharmacother 2018; 107:7-18. [PMID: 30075371 DOI: 10.1016/j.biopha.2018.07.130] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 01/08/2023] Open
Abstract
Management of bacterial infections of central nervous system is a major challenge for the scientists all over the world. Despite the development of various potential drugs, the issue of central nervous system infections persists in the society. The main constraint is the delivery of drugs across the blood brain barrier and only a few drugs after meeting the stringent criteria could cross the blood brain barrier. On the other hand, certain bacterial pathogens could easily enter the brain by using several factors and mechanisms by crossing the blood brain barriers. Interestingly, in the recent past, gold nanoparticles have shown immense potential to overcome the issues associated with the treatment of central nervous system infections, especially due to their inherent ability to cross the blood brain barrier. Initially, the present review summarized the recent updates on the pathogenesis and factors involved in neurological bacterial infections, including the mechanism used by bacterial pathogens to cross the blood brain barriers. Thereafter, the emphasis of the review was on providing current information on gold nanoparticles pertinent to their applicability for the treatment of neurological infections. After discussing the background of neurological bacterial infections, the characteristic features, antibacterial properties, mechanisms of antibacterial action and ability to cross the blood brain barrier of gold nanoparticles have been summarized. Some of the features of gold nanoparticles that make them an ideal candidate for brain delivery are biocompatibity, stability, ability to get synthesized in different sizes with facile methods, surface affinity towards various functional groups, spontaneous crossing of blood brain barrier without applying any external field and most importantly, easy non-invasive tracing by CT imaging. The current updates on the development of gold nanoparticles based therapeutic strategies for the prevention and treatment of central nervous system infections have been discussed in the present study. However, further investigation would be required to translate these preclinical outcomes into clinical applications. Nevertheless, we could safely state that the information gathered and discussed in the present review would benefit the scientists working in the field of neuro-nanotechnology.
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Affiliation(s)
- Syed Mohd Danish Rizvi
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Hail, Hail, Saudi Arabia.
| | - Talib Hussain
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Abo Bakr Fathy Ahmed
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Thamir M Alshammari
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Afrasim Moin
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Mohammed Qumani Ahmed
- Department of Pharmacology, College of Medicine,University of Hail, Hail, Saudi Arabia
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C, Colombia; Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Mohammad Ajmal Kamal
- Enzymoics, 7 Peterlee Place, Hebersham, NSW 2770, Sydney, Australia; Novel Global Community Educational Foundation, Australia; King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
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Sultana NK, Saha SK, Al-Emran HM, Modak JK, Sharker MAY, El-Arifeen S, Cohen AL, Baqui AH, Luby SP. Impact of introduction of the Haemophilus influenzae type b conjugate vaccine into childhood immunization on meningitis in Bangladeshi infants. J Pediatr 2013; 163:S73-8. [PMID: 23773597 PMCID: PMC4629472 DOI: 10.1016/j.jpeds.2013.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Some Asian countries have been reluctant to adopt Haemophilus influenzae type b (Hib) conjugate vaccination because of uncertainty over disease burden. We assessed the impact of introduction of Hib conjugate vaccine into the Expanded Program on Immunization in Bangladesh on purulent and laboratory-confirmed H influenzae meningitis. STUDY DESIGN Within a well-defined catchment area around 2 surveillance hospitals in Dhaka, Bangladesh, we compared the incidence of Hib meningitis confirmed by culture, latex agglutination, and polymerase chain reaction assay among infants 1 year before and 1 year after introduction of Hib conjugate vaccine. We adjusted the incidence rate for the proportion of children who sought care at the surveillance hospitals. RESULTS Among infants, the incidence of confirmed Hib meningitis decreased from 92-16 cases per 100,000 within 1 year of vaccine introduction (vaccine preventable incidence = 76; 95% CI 18, 135 per 100,000). The incidence of purulent meningitis decreased from 1659-1159 per 100,000 (vaccine preventable incidence = 500; 95% CI: 203, 799 per 100,000). During the same time period, there was no significant difference in the incidence of meningitis due to Streptococcus pneumoniae. CONCLUSIONS Introduction of conjugate Hib conjugate vaccine into Bangladesh Expanded Program on Immunization markedly reduced the burden of Hib and purulent meningitis.
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Affiliation(s)
| | - Samir K. Saha
- Department of Microbiology, Bangladesh Institute of Child Health Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Hassan M. Al-Emran
- Department of Microbiology, Bangladesh Institute of Child Health Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Joyanta K. Modak
- Department of Microbiology, Bangladesh Institute of Child Health Dhaka Shishu Hospital, Dhaka, Bangladesh
| | | | - Shams El-Arifeen
- International Center for Diarrheal Disease Research, B (icddr,b)
| | - Adam L. Cohen
- Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Abdullah H. Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Stephen P. Luby
- International Center for Diarrheal Disease Research, B (icddr,b)
- Division of Bacterial Diseases, National Center of Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
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VYSE A, WOLTER JM, CHEN J, NG T, SORIANO-GABARRO M. Meningococcal disease in Asia: an under-recognized public health burden. Epidemiol Infect 2011; 139:967-85. [PMID: 21492496 PMCID: PMC3105449 DOI: 10.1017/s0950268811000574] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2011] [Indexed: 01/02/2023] Open
Abstract
A literature search traced existing information on meningococcal disease in Asia. Reviewed data describing the epidemiology of meningococcal disease in Asia are incomplete, due in part to absence of surveillance in many countries, poor bacterial detection methods and social and healthcare barriers to disease reporting. This suggests that meningococcal disease in some Asian countries may be under-recognized, with a need to introduce/improve existing surveillance and case identification systems. Nevertheless, in some developing Asian countries, the disease burden may be significant. Serogroup A meningococcal epidemics are responsible for high morbidity and mortality in some countries and continue to be an ongoing threat, particularly in developing countries. There is an increasing role played by serogroups C, Y, and W-135 in invasive disease, indicating evolving meningococcal disease epidemiology in some countries. Multivalent meningococcal conjugate vaccines offer new opportunities in the region for reducing the meningococcal disease burden.
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Affiliation(s)
- A. VYSE
- GlaxoSmithKline Biologicals Group of Companies, Wavre, Belgium
| | | | - J. CHEN
- GlaxoSmithKline Biologicals Group of Companies, Wavre, Belgium
| | - T. NG
- GlaxoSmithKline Biologicals Group of Companies, Wavre, Belgium
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Yemadje LP, Houinato D, Quet F, Druet-Cabanac M, Preux PM. Understanding the differences in prevalence of epilepsy in tropical regions. Epilepsia 2011; 52:1376-81. [PMID: 21627649 DOI: 10.1111/j.1528-1167.2011.03099.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Epilepsy is a frequent chronic neurologic disorder that affects nearly 70 million people worldwide. The majority of people with epilepsy live in developing countries, where epilepsy remains a major public health problem. Wide prevalence differences exist among various populations across sub-Saharan Africa, Latin America, and Asia. In particular, prevalence is lower in Southeast Asia than in sub-Saharan Africa and Latin America. Methodologic problems alone do not seem to explain these differences shown in recent review papers. The distribution of numerous risk or etiologic factors such as infectious diseases with neurologic sequel, head injuries, or genetic factors could explain these differences. Stigmatization of people with epilepsy could lead to underestimating the prevalence of epilepsy, even in well-conducted studies. It is important to standardize the process of epidemiologic monitoring of epilepsy in order to improve the reliability in data comparison. Understanding the reasons for these differences is a crucial issue for eventually raising new hypotheses or prevention strategies.
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Affiliation(s)
- Luce-Perrine Yemadje
- University of Limoges, IFR 145 GEIST, Institute of Tropical Neurology, EA 3174 Comparative and Tropical Neuroepidemiology, Limoges, France
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Hui ACF, Ng KC, Tong PY, Mok V, Chow KM, Wu A, Wong LKS. Bacterial meningitis in Hong Kong: 10-years’ experience. Clin Neurol Neurosurg 2005; 107:366-70. [PMID: 16023529 DOI: 10.1016/j.clineuro.2004.10.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Revised: 09/29/2004] [Accepted: 10/04/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We studied the etiology, clinical features and outcome of patients with bacterial meningitis from an urban Chinese city over a 10-years period. METHODS We reviewed the files of all persons aged 15-years old or above diagnosed with community-acquired bacterial meningitis from a regional hospital. The clinical findings, relevant laboratory and imaging results as well as outcome were recorded in cases with microbiological evidence of meningitis. Neurosurgical and pediatric patients were excluded. RESULTS Sixty-five patients between the ages of 15 and 86 years of age (mean 52 years) were identified of whom 18 (28%) died. The four most common causes were Mycobacteria tuberculosis (46%), Streptococcus pneumoniae (11%), Streptococcus suis (9%) and Klebsiella pneumoniae (8%). Neisseria meningitidis and Haemophilus influenzae were rare pathogens. The annual incidence of community-acquired bacterial meningitis was 1.27/100,000 adults. Delay in treatment was associated with a poorer prognosis (p<0.001, OR=38.84, CI=7.33-205.80). CONCLUSION The causative organisms found in this region of China differ from that reported from Europe and the US; tuberculous meningitis is the most common cause of bacterial meningitis.
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Affiliation(s)
- A C F Hui
- Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Ngan Shing Street, New Terriotories, Shatin, Hong Kong SAR.
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Rerks-Ngarm S, Treleaven SC, Chunsuttiwat S, Muangchana C, Jolley D, Brooks A, Dejsirilert S, Warintrawat S, Guiver M, Kunasol P, Maynard JE, Biggs BA, Steinhoff M. Prospective population-based incidence of Haemophilus influenzae type b meningitis in Thailand. Vaccine 2004; 22:975-83. [PMID: 15161074 DOI: 10.1016/j.vaccine.2003.09.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2003] [Accepted: 09/08/2003] [Indexed: 11/20/2022]
Abstract
There are limited prospective data for Haemophilus influenzae type b (Hib) disease in Asia, where some countries are considering vaccine introduction. A prospective population-based study was conducted to measure the incidence of Hib meningitis in children in two northern provinces of Thailand. Children <5 years with symptoms consistent with bacterial meningitis were enrolled in the study if inclusion criteria were met. The study enrolled 598 children with clinical meningitis, 76% of whom received lumbar puncture. The rate of probable bacterial meningitis was 26.6/100,000 children <5 years per year. There were four cases of laboratory confirmed Hib meningitis (rate 3.8/100,000 children <5 years per year). These findings suggest a relatively low incidence of Hib meningitis. However, additional data from studies of pneumonia are needed to define the Hib disease burden in Thailand.
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Abstract
Bacterial meningitis caused by Haemophilus influenzae type B (Hib) has almost disappeared from the United States, Canada, and other countries that have implemented routine vaccination with Hib conjugate vaccines. The overall incidence of meningitis in these countries has declined by more than 50%, and the age distribution of susceptibility has shifted, so that the disease is now more common in adults than in children. Another new feature of the epidemiology of bacterial meningitis has been the occurrence of clusters of meningococcal disease. Such clusters have been school related, mainly in adolescents, and most clusters have been associated with a clone of group C, serotype 2a. The role of cigarette smoking as a risk factor for bacterial meningitis has been confirmed and adds urgency to the efforts to control smoking in adolescents and young adults.
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Affiliation(s)
- R Gold
- Department of Pediatrics, and Faculty of Medicine, University of Toronto, Ontario, Canada.
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