Background: Nigeria accounts for about 10%

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In December 2008 an outbreak of Meningococcal Meningitis swept across sub Saharan Africa with Nigeria, especially its northern states worst affected. The management of Aminu Kano Teaching Hospital constituted an Emergency Preparedness & Response (EPR) committee. Over the course of 18 weeks from 5 January 2009 to 15 May 2009, AKTH managed 222 cases of suspected meningitis with 14 deaths (case fatality rate [CFR] of 6.3%). Twenty three per cent (23%) were microbiologically proven as meningococcal meningitis while 9% were confirmed to be pneumococcal meningitis. Male to female ratio was 1:1 with most patients (81%) aged below 14 years. The epidemic peaked in weeks 10 and 13 with 38 admissions in the respective weeks. Meningococcemia with purpura fulminans, post meningitic immune complex cutaneous vasculitis and polyarthritis were observed. Control measures instituted included provision of free ceftriaxone, chemoprophylaxis to contacts, vaccines to staff/families, and creation of dedicated isolation wards. Clinical management guidelines were developed and hospital staffs were also enlightened. Lessons learnt included the difficulty of discriminating between nosocomial transmission and community clusters; relative increase in pneumococcal meningitis during the epidemic; unreliability of penicillin/chloramphenicol; the utility of internet for communication; and the inadequacy of vaccines to meet staff & public demand.

In Nigeria, snake bite envenoming has remained a significant health problem. Most snake bites in Nigeria and elsewhere predominantly involve the limbs (upper and lower) but may involve other areas of the body depending on time and posture. Our index patient is a rare case of snake bite that involved the face while the child was asleep at night in a rural Fulani village, Nigeria. The challenges to the child’s management which included late presentation to the hospital and non availability of antisnake venom underscores the need for greater commitment on the part of government at various levels to stock and subsidise the price of antisnake venom in snake- bite prone areas.Keywords: snake, envenoming, face.

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