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Bacterial meningitis in a rural Kenyan hospital
1Norweigian University of Science and Technology, Trondheim, Norway.
Abstract:
In a prospective study to investigate mortality and antibiotic resistance in meningitis patients, thirty two meningitis cases were seen over a three month period. Mean age was 11.3 years (range one month-60 years). Cerebrospinal fluid cultures were positive in 26 patients (81.3%). S.pneumoniae was responsible for 15 cases (46.9%), followed by H.influenzae in seven (21.9%). Salmonella infection was seen in two patients, and E.coli and N.meningitidis in one each. Twelve patients (37.5%) died during hospitalisation with most of the deaths occurring within 48 hours after admission. No patients presented with atypical signs of meningitis. No significant differences were found between delay and outcome. Malaria parasites were found in blood of thirteen patients (41%), but did not contribute to higher mortality. Three of H.influenzae isolates (42.9%) were resistant to ampicillin and penicillin. Reduced sensitivity to penicillin was found in two (13.3%) of S.pneumoniae isolates.
Insights
This study on meningitis cases found high mortality and emerging antibiotic resistance, particularly in Streptococcus pneumoniae and Haemophilus influenzae, highlighting urgent public health concerns.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Meningitis remains a significant cause of mortality and morbidity worldwide.
- Antibiotic resistance poses a growing threat to effective meningitis treatment.
Purpose of the Study:
- To investigate mortality rates associated with meningitis.
- To determine the prevalence of antibiotic resistance in meningitis pathogens.
Main Methods:
- Prospective study of 32 meningitis cases over three months.
- Cerebrospinal fluid cultures and antimicrobial susceptibility testing performed.
- Analysis of patient demographics, clinical presentation, and outcomes.
Main Results:
- High rate of positive cerebrospinal fluid cultures (81.3%).
- Streptococcus pneumoniae (46.9%) and Haemophilus influenzae (21.9%) were the most common pathogens.
- Mortality rate was 37.5%, with most deaths within 48 hours of admission.
- Antibiotic resistance observed: 42.9% of H. influenzae resistant to ampicillin/penicillin; 13.3% of S. pneumoniae showed reduced penicillin sensitivity.
Conclusions:
- Meningitis presents a substantial mortality risk, often rapid after admission.
- Emerging antibiotic resistance in key bacterial pathogens like S. pneumoniae and H. influenzae is a critical concern.
- Co-infection with malaria did not significantly impact mortality in this cohort.