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Etiology and mortality of bacterial meningitis in northeastern Brazil
J P Bryan1, H R de Silva, A Tavares
1Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville.
Abstract:
Little is known of the current incidence and mortality of meningitis in developing nations, especially in Latin America. We reviewed all cases of meningitis in an isolation-fever hospital in Salvador, Brazil, for the decade 1973-1982. Of all admissions, 6,751 (27%) were for meningitis; 4,100 (61%) of these cases were of definite or probable bacterial etiology. Children younger than 15 years accounted for 79% of cases, and 45% of cases were in children under 2 years. The overall case fatality rate was 33%, with 50% of these deaths occurring within 48 hours of hospitalization. Neisseria meningitidis was the etiologic agent in 32% of the cases, with a case fatality rate of 14%. Epidemics caused by N. meningitidis group C, then group A, in 1974-1978 accounted for 60% of the cases. Streptococcus pneumoniae caused 17% of cases, with a case fatality rate of 59%. Haemophilus influenzae type b, the most common cause of nonepidemic meningitis, caused 23% of all cases, with a case fatality rate of 38%. Enterobacteriaceae were the etiology in only 3.6% of patients, but the case fatality rate was 86%. Cultures were negative in 18% of cases with purulent cerebrospinal fluid. A total of 84% of H. influenzae, 40% of S. pneumoniae, 78% of Enterobacteriaceae, and 15% of N. meningitidis cases occurred in children less than 2 years of age. Case fatality rates were highest in this group. Vaccines protective for this age group are urgently needed.
Insights
Bacterial meningitis is a significant threat in developing nations, particularly affecting young children. High mortality rates underscore the urgent need for effective vaccines against common pathogens like Haemophilus influenzae type b.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Meningitis incidence and mortality data are scarce in developing countries, especially Latin America.
- This study examines meningitis cases over a decade in Salvador, Brazil.
Purpose of the Study:
- To determine the incidence, etiology, and mortality of meningitis in Salvador, Brazil.
- To identify the most common bacterial pathogens and their associated fatality rates.
- To highlight the need for targeted interventions and vaccines, particularly for vulnerable age groups.
Main Methods:
- Retrospective review of meningitis cases admitted to an isolation-fever hospital from 1973 to 1982.
- Analysis of demographic data, causative agents, and case fatality rates.
- Categorization of bacterial etiologies including Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, and Enterobacteriaceae.
Main Results:
- Meningitis accounted for 27% of admissions (6,751 cases), with 61% bacterial etiology (4,100 cases).
- Children under 15 comprised 79% of cases; 45% were under 2 years.
- Overall case fatality rate was 33%, highest in infants. Neisseria meningitidis (32% of cases, 14% CFR), Streptococcus pneumoniae (17% of cases, 59% CFR), Haemophilus influenzae type b (23% of cases, 38% CFR), and Enterobacteriaceae (3.6% of cases, 86% CFR) were identified.
- Epidemics of N. meningitidis occurred in 1974-1978.
Conclusions:
- Bacterial meningitis poses a substantial public health challenge in developing nations, with high mortality.
- Young children, especially infants, are disproportionately affected and experience the highest fatality rates.
- Development and implementation of vaccines against key pathogens like H. influenzae type b are critically needed for this age group.