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[Non-tubercular bacterial meningitis in children in Antananarivo, Madagascar]
R Migliani1, J Clouzeau, J W Decousser
1Institut Pasteur, BP 1274, Antananarivo, Madagascar. rmiglian@pasteur.mg
Insights
Bacterial meningitis in children is primarily caused by Streptococcus pneumoniae and Haemophilus influenzae b. Early vaccination against H. influenzae and prompt antibiotic treatment are crucial for reducing severe complications and mortality.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Bacterial meningitis poses a significant threat to children's health, particularly in developing regions.
- Identifying causative agents and their antimicrobial resistance patterns is vital for effective treatment and prevention strategies.
Purpose of the Study:
- To identify the bacterial pathogens responsible for meningitis in children aged one month to 14 years.
- To analyze the antimicrobial resistance patterns of these identified pathogens.
Main Methods:
- A two-year prospective study was conducted in Antananarivo involving children with suspected bacterial meningitis.
- Diagnostic methods included cerebrospinal fluid analysis, Gram staining, bacterial culture, and antimicrobial sensitivity testing.
Main Results:
- Streptococcus pneumoniae (45%) and Haemophilus influenzae b (43%) were the predominant pathogens. Neisseria meningitidis accounted for 10% of cases.
- While sensitive to penicillin G and third-generation cephalosporins, resistance to chloramphenicol and aminoglycosides was noted in S. pneumoniae, and resistance to gentamicin and amoxicillin in H. influenzae.
- The study reported a high mortality rate of 31%, with 30% of survivors experiencing neurosensitive disorders.
Conclusions:
- Vaccination against Haemophilus influenzae b should be integrated into Madagascar's national immunization program.
- Early diagnosis and treatment with appropriate antibiotics, such as third-generation cephalosporins, are essential to mitigate severe outcomes of bacterial meningitis.
Objective:
To determine the bacterial causal agents of meningitis and their pattern of resistance, in children more than one month to 14 years of age.
Methods:
A 2 years, prospective study (June 1998 to June 2000) on bacterial meningitis in children was carried out in the main hospitals in Antananarivo. The enrollment criteria upon admission were fever with symptoms of meningitis and/or convulsions and/or coma. A lumbar puncture was systematically performed in each child. The aspect of the cerebrospinal fluid was described, the level of protein and glucose estimated, soluble antigens measured. Following the examination of a Gram straining, an aliquot of the fluid was cultured on specific medium. Antimicrobial sensitivity testing of isolated pathogens was performed.
Results:
Bacterial meningitis was confirmed in 119 children: 95 (80%) and 111 (93%) were less than 12 and 24 months of age, respectively. The sex distribution was 1:1. Three predominant microorganisms were identified: Streptococcus pneumoniae (45%), Haemophilus influenzae b (43%) and Neisseria meningitidis (10%) of which ten of 12 cases were belonging to serogroup B. The other microorganisms isolated were E. coli (2%). S. pneumoniae were found to be sensitive to penicillin G and H. influenzae were found to be sensitive to the third generation cephalosporins. Seven percent of the S. pneumoniae strains were mildly resistant (R + I) to chloramphenicol and between 29 and 50% to aminoglucosides. A moderate resistance against gentamicin and amoxicillin was found in 22-29% of the H. influenzae strains. The mortality rate was high (31%) and among the surviving children 30% presented with neurosensitive disorders.
Conclusion:
According to these data we may recommend the inclusion of vaccination against H. influenzae in the children immunization program in Madagascar. The early diagnosis and treatment with appropriate antibiotics, such as third generation of cephalosporins, are other critical measures to be taken in order to reduce the risk of developing severe complications associated to bacterial meningitis.