Surveillance of bacterial meningitis in an Angolan pediatric hospital after the introduction of pneumococcal conjugate vaccines

Urtti, Suvi; Cruzeiro, Manuel Leite; Gouveia, Linda de; Peltola, Heikki; Gottberg, Anne von; Kyaw, Moe H.; Pelkonen, Tuula

doi:10.29392/joghr.3.e2019091

Cited by 4 publications

(5 citation statements)

References 30 publications

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“…17 If available, the rest of CSF sample was frozen and shipped for PCR identification to Centre for Respiratory Diseases and Meningitis, Johannesburg (detailed information published earlier). 14,15…”

Section: Methodsmentioning

confidence: 99%

“…This prospective, observational, single-site and descriptive study is a part of a larger study whose primary objective was to assess the etiology of BM between February 1, 2016, and October 23¸2017. 14,15 All <90-day-old infants who underwent LP successfully were included. LPs were performed under the World Health Organization (WHO)-guided suspicion of neonatal sepsis or BM.…”

Section: Methodsmentioning

confidence: 99%

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Accuracy of Clinical and Cerebrospinal Fluid Indicators in the Diagnosis of Bacterial Meningitis in Infants <90 Days of Age in Luanda, Angola

Pelkonen

Urtti

Cardoso

et al. 2021

Pediatric Infectious Disease Journal

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Background:The diagnosis of bacterial meningitis (BM) is problematic in young infants, as clinical features may be nonspecific or even absent. Cerebrospinal fluid (CSF) analysis usually confirms the diagnosis, but the CSF parameters can be normal also in culture-proven BM. Our objective was to identify the clinical and CSF indices, that quickly and without laboratory likely lead to the diagnosis of confirmed of probable BM in young infants in Angola. Methods: We conducted a prospective, observational, single-site study from February 2016 to October 2017 in the Pediatric Hospital of Luanda. All assessed infants showed symptoms and signs compatible of BM or neonatal sepsis and were <90 days of age. Results: Of the 1088 infants, 212 (19%) showed bacteria in CSF, while 88 (8%) had probable BM. Independent clinical indicators of BM were notclear CSF, seizures, weight <2500 g and illness >7 days. In infants with BM, CSF leukocytes were >10 × 10 6 /L in 46%, CSF glucose <25 mg/dL in 43% and CSF protein >120 mg/dL in 58%. All measured parameters were in normal range in 25% of patients. In 515 infants with normal CSF parameters, bacteria were found in 74 (14%). In these infants, illness >7 days, weight <2500 g and malnutrition increased the probability of BM. Conclusions: Our study confirms and underlines the problems in diagnosing BM in young infants. While the CSF parameters were normal in 25% of infants, the easily recognizable unclear appearance of CSF was the single strongest predictor of BM.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Accuracy of Clinical and Cerebrospinal Fluid Indicators in the Diagnosis of Bacterial Meningitis in Infants <90 Days of Age in Luanda, Angola

Pelkonen

Urtti

Cardoso

et al. 2021

Pediatric Infectious Disease Journal

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“…There were no exclusion criteria. Data for older children have been published before (Urtti et al, 2019).…”

Section: Methodsmentioning

confidence: 99%

Aetiology of bacterial meningitis in infants aged <90 days: Prospective surveillance in Luanda, Angola

Pelkonen

Urtti

Anjos

et al. 2020

International Journal of Infectious Diseases

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Background: Despite effective antibiotics and vaccines, bacterial meningitis (BM) remains one of the leading causes of morbidity and mortality in young infants worldwide. Data from Africa on the aetiology and antibiotic susceptibility are scarce. Objective: To describe the aetiology of BM in Angolan infants <90 days of age. Methods: A prospective, observational, single-site study was conducted from February 2016 to October 2017 in the Paediatric Hospital of Luanda. All cerebrospinal fluid samples (CSF) from infants aged <90 days with suspected BM or neonatal sepsis were assessed. The local laboratory performed microscopy, chemistry, culture, and susceptibility testing. PCR for vaccine-preventable pathogens was performed in Johannesburg, South Africa. Results: Of the 1287 infants, 299 (23%) had confirmed or probable BM. Of the 212 (16%) identified bacterial isolates from CSF, the most common were Klebsiella spp (30 cases), Streptococcus pneumoniae (29 cases), Streptococcus agalactiae (20 cases), Escherichia coli (17 cases), and Staphylococcus aureus (11 cases). A fifth of pneumococci (3/14; 21%) showed decreased susceptibility to penicillin, whereas methicillin-resistant S. aureus (MRSA) was encountered in 4/11 cases (36%). Of the gram-negative isolates, 6/45 (13%) were resistant to gentamicin and 20/58 (34%) were resistant to third-generation cephalosporins. Twenty-four percent (33/135) of the BM cases were fatal, but this is likely an underestimation. Conclusions: BM was common among infants <90 days of age in Luanda. Gram-negative bacteria were predominant and were often resistant to commonly used antibiotics. Continued surveillance of the antibiogram is pivotal to detect potential changes without delay.

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“…Both are administered at 2, 4, and 6 months of age. The current estimates of the coverage of three doses of DTP vaccine in children in Angola range from 48% to 84% [12,13], while estimates for PCV13 vaccination rates range from 59% to 82% [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…Routine immunizations in Angola include the pentavalent vaccine (i.e., diphtheria–tetanus–pertussis (DTP), hepatitis B, and H. influenzae type b), which was introduced in 2006, and the 13-valent pneumococcal vaccine (PCV13), which was introduced in 2013 [ 11 ]. Both are administered at 2, 4, and 6 months of age.…”

Section: Introductionmentioning

confidence: 99%

Gene Polymorphisms of TLR4 and TLR9 and Haemophilus influenzae Meningitis in Angolan Children

Tenhu

Teräsjärvi

Cruzeiro

et al. 2020

Genes

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Bacterial meningitis (BM) is a severe disease caused by various bacterial pathogens. Toll-like receptors (TLRs) protect humans from invading pathogens. In this study, we determined whether single nucleotide polymorphisms (SNPs) of TLR4 and TLR9 are associated with susceptibility to and outcome of BM in Angolan children. Samples were taken from 241 patients and 265 age-matched ethnic controls. The SNPs TLR4 rs4986790 (896A > G) and TLR9 rs187084 (−1486T > C) were determined by high-resolution melting analysis (HRMA). The frequency of variant genotypes in TLR4 was significantly higher in patients with Haemophilus influenzae meningitis than controls (odds ratio (OR), 2.5; 95% confidence interval (CI), 1.2–5.4; p = 0.021), whereas the frequency of variant genotypes in TLR9 was significantly lower in patients with H. influenzae meningitis than controls (OR, 0.4; 95% CI, 0.2–0.9; p = 0.036). No such differences were found with other causative pathogens, such as Streptococcus pneumoniae and Neisseria meningitidis. At the time of discharge, patients with meningitis caused by Gram-negative bacteria who were carriers of variant TLR4 genotypes had a higher risk of ataxia (OR, 12.91; 95% CI, 1.52–109.80; p = 0.019) and other neurological sequelae (OR, 11.85; 95% CI, 1.07–131.49; p = 0.044) than those with the wild-type TLR4 genotype. Our study suggests an association between H. influenzae meningitis and genetic variation between TLR4 and TLR9 in Angolan children.

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Surveillance of bacterial meningitis in an Angolan pediatric hospital after the introduction of pneumococcal conjugate vaccines

Cited by 4 publications

References 30 publications

Accuracy of Clinical and Cerebrospinal Fluid Indicators in the Diagnosis of Bacterial Meningitis in Infants <90 Days of Age in Luanda, Angola

Accuracy of Clinical and Cerebrospinal Fluid Indicators in the Diagnosis of Bacterial Meningitis in Infants <90 Days of Age in Luanda, Angola

Aetiology of bacterial meningitis in infants aged <90 days: Prospective surveillance in Luanda, Angola

Gene Polymorphisms of TLR4 and TLR9 and Haemophilus influenzae Meningitis in Angolan Children

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