Background Historically, Nigeria has experienced large bacterial meningitis outbreaks with high mortality in children. Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae are major causes of this invasive disease. In collaboration with the World Health Organization, we conducted longitudinal surveillance in sentinel hospitals within Nigeria to establish the burden of pediatric bacterial meningitis (PBM). Methods From 2010 to 2016, cerebrospinal fluid was collected from children <5 years of age, admitted to 5 sentinel hospitals in 5 Nigerian states. Microbiological and latex agglutination techniques were performed to detect the presence of pneumococcus, meningococcus, and H. influenzae. Species-specific polymerase chain reaction and serotyping/grouping were conducted to determine specific causative agents of PBM. Results A total of 5134 children with suspected meningitis were enrolled at the participating hospitals; of these 153 (2.9%) were confirmed PBM cases. The mortality rate for those infected was 15.0% (23/153). The dominant pathogen was pneumococcus (46.4%: 71/153) followed by meningococcus (34.6%: 53/153) and H. influenzae (19.0%: 29/153). Nearly half the pneumococcal meningitis cases successfully serotyped (46.4%: 13/28) were caused by serotypes that are included in the 10-valent pneumococcal conjugate vaccine. The most prevalent meningococcal and H. influenzae strains were serogroup W and serotype b, respectively. Conclusions Vaccine-type bacterial meningitis continues to be common among children <5 years in Nigeria. Challenges with vaccine introduction and coverage may explain some of these finding. Continued surveillance is needed to determine the distribution of serotypes/groups of meningeal pathogens across Nigeria and help inform and sustain vaccination policies in the country.

The human immunodeficiency virus (HIV) infection is a multi-systemic illness and often leads to acquired immunodeficiency syndrome (AIDS) in untreated cases. In children, neurologic manifestations are common. HIV encephalopathy is a neurological dysfunction arising from direct HIV infection of the brain. It ranges between 30% to 50% in untreated cases and 5% to 10% in those on Highly Active Anti-retroviral Therapy (HAART). There is a paucity of information on neurological manifestations of HIV/AIDS in children from sub-Sahara Africa. We reviewed the records of all consecutive HIV infected non-neonatal children presenting to the pediatric department of the University of Benin Teaching Hospital, Benin City, Nigeria, between January 1999 and December 2004. Those who had neurologic manifestations were included in the study. Their biodata, the results of cerebrospinal fluid analysis, Mantoux tests and acid- and alcohol-fast bacilli (AAFB) determination were obtained. The HIV sero-status was determined using enzyme-linked immunosorbent assay test and confirmed by Western blot. In children less than 18 months, the Centers for Disease Control (CDC) criteria for surveillance case definition for AIDS were used. HIV encephalopathy was diagnosed based on CDC revised classification criteria. Of the 203 HIV seropositive children, 15 (7.4%) had neurologic manifestations. The most common manifestations were brisk deep tendon reflexes in 14 (93.3%), extensor plantar responses in 10 (66.7%) and cortical fisting in eight (53.3%). The male/female ratio was 1:2; mean age was 7.7 ? 4.8 months (range 3?18 months). As a result of cost, five (33.3%) patients had their CD4+ count determined on presentation and ranged between 30 and 300/?L. Of the 15 patients, 12 (80.0%) died, eight while in hospital and four at follow-up visit. Three patients were lost to follow-up. Five patients received HAART for a mean 11.3 ? 2.5 weeks (range 7?14 weeks). Children with HIV/AIDS present with severe neurologic manifestations and often delay in seeking appropriate medical care. It is envisioned that the promotion of the ?Prevention of Mother to Child Transmission? program coupled with early therapy with HAART, will prevent the high mortality currently associated with this condition.

Schizencephaly is a rare congenital malformation of the brain that could present with repeated seizures. We report a case of a 17-year-old boy who presented with status epilepticus. Further radiological evaluation revealed unilateral open lip schizencephaly. Seizure was well controlled with anti-epileptic drug and there was no need for surgical intervention. This case highlights the need for prompt radiological evaluation of patients with seizures, especially in resource-limited settings where the high cost and non-availability of such facilities might be a major impediment.

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