Endemic bacterial meningitis in Sudanese children: aetiology, clinical findings, treatment and short-term outcome

Abstract

During the period April 1985 to November 1986 (18 months), 196 children (of age greater than 1 month) admitted to the Children's Emergency Hospital in Khartoum, Sudan, with clinical suspicion of meningitis/meningoencephalitis were followed up prospectively. Bacterial meningitis was diagnosed by culture, direct microscopy and/or antigen-detecting assays (co-agglutination and enzyme immunoassay) in 44 infants (25 Haemophilus influenzae type b, 8 Neisseria meningitidis, 7 Streptococcus pneumoniae, 3 enterobacteria and one mixed infection), aseptic meningitis in 52, cerebral malaria in 4 and febrile convulsions in 96. The majority of cases of bacterial meningitis were boys and 57% of those in whom H. influenzae was the commonest isolate were less than 1 year old. The presenting signs and symptoms are described as well as the transient and permanent short-term sequelae. The total mortality from bacterial meningitis was 19%, permanent neurological sequelae were seen in 26% of survivors. Prospective follow-up, including audiometry, of 35 children 1-2 months after discharge showed that 11% had hemiplegia and 20% had hearing impairment. The potential impact of vaccination against invasive H. influenzae infections is discussed.

Different seroprevalences of antibodies against Neisseria meningitidis serogroup A and Haemophilus influenzae type b in Sudanese and Swedish children

“…However, in both Sudan and Sweden Hib accounts for more than half of the cases of ABM among children in the non-epidemic situation [9,10] with a documented increased incidence in Sweden since 1970 [9]. Reliable proportion of Hib in both countries is followed by MC which accounted for 27 % of the cases in Sweden [9] and 18% in Sudan [10]. In Sweden PNC caused less than 10% of ABM among children but was higher, 16%, in Sudan [9,10].…”

“…Reliable proportion of Hib in both countries is followed by MC which accounted for 27 % of the cases in Sweden [9] and 18% in Sudan [10]. In Sweden PNC caused less than 10% of ABM among children but was higher, 16%, in Sudan [9,10].…”

“…The distribution of the three most important causative organisms for ABM, Haemophilus infiuenzae type b (Hib), Neisseria meningitidis (MC) and Streptococcus pneumoniae (PNC), varies in different populations. However, in both Sudan and Sweden Hib accounts for more than half of the cases of ABM among children in the non-epidemic situation [9,10] with a documented increased incidence in Sweden since 1970 [9]. Reliable proportion of Hib in both countries is followed by MC which accounted for 27 % of the cases in Sweden [9] and 18% in Sudan [10].…”

Study of CSF C-reactive protein in meningitis to differentiate bacterial meningitis from aseptic meningitis in children between 1 month and 12 years of age

“…1 Case fatality ranges from 5-50% depending upon the level of care provided with higher rates in developing countries like India. [2][3][4] A further 15-20% of survivors sustain neurological sequelae. of inadequate and inappropriate antibiotics prior to diagnostic test may cause alterations in the biochemistry and cytology of CSF and organisms may not be isolated from CSF thereby misleading the diagnosis.…”

Role of CSF C-Reactive Protein for the Differentiation of Bacterial Meningitis from Aseptic Meningitis in Children

“…Case fatality rates for bacterial meningitis range from 4.5% in developed countries to15-50% in developing countries 2,3,4 . A further 15-20% of survivors sustain neurological sequelae 5,6 .…”