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Encephalitis and meningitis in Western Africa: a scoping review of pathogens
Shawheen J Rezaei1, Farrah J Mateen1,2
1Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
Objective:
To give an overview of the recently reported literature on the aetiologies of meningitis and encephalitis in western sub-Saharan Africa.
Methods:
We conducted a scoping review following PRISMA guidance on published meningitis and encephalitis cases in the 16 countries of the United Nations-defined western sub-Saharan African region as identified in cohort studies, case series, and case reports, published 01/01/2000-08/01/2020, and available in four databases in August 2020 with an abstract in English, French or Italian.
Results:
There were 38 distinct pathogens identified from 91 cohort studies' data and 48 case reports or case series' data. In cohort-level data, the majority of cases were caused by Neisseria meningitidis (71.5%), Streptococcus pneumoniae (17.6%) and Haemophilus influenzae (7.3%). In case report- and case series-level data, 40.5% of patients were <18 years old, 28.6% were female, and 28.6% were known to be immunocompromised. The case fatality rate was 39.3%. The most commonly reported pathogens among immunocompetent patients were Salmonella species (13 cases) and Ebola virus (9 cases), and the most commonly reported pathogen among immunocompromised patients was Cryptococcus neoformans (18 cases). Most cohort cases (52.3%) derived from Niger followed by Burkina Faso (28.6%). Most cases from single reports or series were reported from Nigeria (21.4%), Mali (20.2%) and Burkina Faso (19.0%).
Conclusions:
Given the small number of pathogens reported, our findings underscore the need to better screen, diagnose and monitor populations in western sub-Saharan Africa for additional CNS pathogens, including those posing significant outbreak risks.
Insights
Meningitis and encephalitis in western sub-Saharan Africa are caused by various pathogens. Enhanced surveillance is needed to identify additional central nervous system pathogens and mitigate outbreak risks.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Meningitis and encephalitis pose significant health challenges in western sub-Saharan Africa.
- Understanding the causative pathogens is crucial for effective prevention and treatment.
Purpose of the Study:
- To provide an overview of reported pathogens causing meningitis and encephalitis in western sub-Saharan Africa.
- To identify gaps in current knowledge and surveillance.
Main Methods:
- A scoping review of published literature from 2000 to 2020 was conducted.
- Data were extracted from cohort studies, case series, and case reports across 16 countries.
- PRISMA guidance was followed for the review process.
Main Results:
- 38 distinct pathogens were identified.
- Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae were common in cohort data.
- Cryptococcus neoformans was prevalent in immunocompromised patients, while Salmonella and Ebola virus were noted in immunocompetent individuals.
Conclusions:
- Current surveillance may miss crucial central nervous system (CNS) pathogens.
- Enhanced screening, diagnosis, and monitoring are essential for populations in western sub-Saharan Africa.
- Addressing these gaps can help mitigate significant outbreak risks.
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