Acute childhood bacterial meningitis in Luanda, Angola

Pelkonen, Tuula; Roine, Irmeli; Monteiro, Lurdes; Simões, Maria João; Anjos, Elizabete; Pelerito, Ana; Pitkäranta, Anne; Bernardino, Luís; Peltola, Heikki

doi:10.1080/00365540802262091

Cited by 17 publications

(20 citation statements)

References 22 publications

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“…Streptococcus pneumoniae –a Gram-positive bacteria- is likely the most important pathogen responsible for BM in our sample population as it appeared in 70.37% within positive Gram-staining specimens; Neisseria meningitidis –a Gram-negative bacteria- is less present (26.63%). These findings are consistent with other results reported in Angola after the introduction of the Hib vaccine [12], [22]. As interpretation of Gram staining requires trained biologists or lab-technicians we discourage to use routinely Gram staining in BM diagnosis and we suggest that interpretation of Gram staining results has to be accompanied by other BM predictors as CSF WBC count, CSF glucose or protein concentration.…”

Section: Discussionsupporting

confidence: 90%

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Predictors of Bacterial Meningitis in Resource-Limited Contexts: An Angolan Case

et al. 2011

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BackgroundDespite the great morbidity and mortality that childhood bacterial meningitis (BM) is experiencing in Africa, diagnosis of BM in resource-limited contexts is still a challenge. Several algorithms and clinical predictors have been proposed to help physicians in decision-making but a lot of these markers used variables that are calculable only in well-equipped laboratories. Predictors or algorithm based on parameters that can be easily performed in basic laboratories can help significantly in BM diagnosis, even in resource-limited settings, rural hospitals or health centers.ResultsThis retrospective study examined 145 cerebral-spinal fluid (CSF) specimens from children from 2 months to 14 years. CSF specimens were divided into two groups, according to the presence or not of a clinical diagnosis of BM. For each specimen, CSF aspect, CSF white blood cells (WBC) count, CSF glucose and protein concentration were analyzed and statistical analysis were performed. CSF WBC count ≥10/µl is no more a valuable predictor of BM. CSF protein concentration ≥50 mg/dl has a better sensitivity for BM diagnosis and when used with CSF glucose concentration ≤40 mg/dl, can help to diagnose correctly almost all the BM cases. An algorithm including CSF protein concentration, glucose concentration and WBC count has been proposed to rule out BM and to correctly diagnose it.ConclusionsIn resource-limited health centers, the availability of a combination of easy-to-obtain parameters can significantly help physicians in BM diagnosis. The prompt identification of a BM case can be rapid treated or transferred to adequate structures and can modify the outcome in the patient.

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Section: Discussionsupporting

confidence: 90%

“…All the children who underwent a lumbar puncture at Divina Providencia Hospital belonged to a low socioeconomic group, which represents 90% of Luanda population [22]. Malnourishment was common, at 35%, being severe in 15% of cases and moderate in 85% of cases.…”

Section: Resultsmentioning

confidence: 99%

Predictors of Bacterial Meningitis in Resource-Limited Contexts: An Angolan Case

et al. 2011

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“…It has been reported that Streptococcus pneumoniae , Neisseria meningitidis , and Haemophilus influenzae type b were among the most prevalent pathogens causing this disease [3–6]. However, the prevalence and etiologies of meningitis pathogens may vary during different times, in geographical regions, and according to the age of the patients [3, 7–13]. Moreover, the effectiveness of treatment may be limited due to antibiotic-resistant bacterial strains.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and antibiotic resistance profiles of cerebrospinal fluid pathogens in children with acute bacterial meningitis in Yunnan province, China, 2012-2015

Jiang

Kui

et al. 2017

PLoS ONE

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Acute bacterial meningitis is still considered one of the most dangerous infectious diseases in children. To investigate the prevalence and antibiotic resistance profiles of cerebrospinal fluid (CSF) pathogens in children with acute bacterial meningitis in Southwest China, CSF samples from 179 meningitis patients (3 days to 12 years old) with positive culture results were collected from 2012 to 2015. Isolated pathogens were identified using the Vitek-32 system. Gram stain results were used to guide subcultures and susceptibility testing. The antimicrobial susceptibility of isolates was determined using the disc diffusion method. Of the isolates, 50.8% were Gram-positive bacteria, and 49.2% were Gram-negative bacteria. The most prevalent pathogens were E. coli (28.5%), Streptococcus pneumoniae (17.8%), Staphylococcus epidermidis (10.0%), Haemophilus influenzae type b (9.5%), and group B streptococcus (7.2%). In young infants aged ≤3 months, E. coli was the organism most frequently isolated from CSF (39/76; 51.3%), followed by group B streptococcus (13/76; 17.1%) and Streptococcus pneumoniae (8/76; 10.5%). However, in young infants aged >3 months, the most frequently isolated organism was Streptococcus pneumoniae (24/103; 23.3%), followed by Staphylococcus epidermidis (18/103; 17.5%) and Haemophilus influenzae type b (16/103; 15.5%). Antimicrobial susceptibility tests indicated that for E. coli isolates, the susceptibility rates to aminoglycosides ranged from 56.8% to 100.0%, among them, amikacin was identified as the most effective against E. coli. As for cephalosporins, the susceptibility rates ranged from 29.4% to 78.4%, and cefoxitin was identified as the most effective cephalosporin. In addition, the susceptibility rates of piperacillin/tazobactam and imipenem against E. coli were 86.3% and 100%. Meanwhile, the susceptibility rates of Streptococcus pneumoniae isolates to penicillin G, erythromycin, chloramphenicol, ceftriaxone and tetracycline were 68.8%, 0.0%, 87.5%, 81.3% and 0.0%, respectively. Gentamycin, ofloxacin, linezolid and vancomycin were identified as the most effective antibiotics for Streptococcus pneumoniae, each with susceptibility rates of 100%. It was notable that other emerging pathogens, such as Listeria monocytogenes and group D streptococcus, cannot be underestimated in meningitis.

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“…[5] A study from Angola on bacterial meningitis in children (10%MM), found an average of 15,000 leukocytes in the blood and an average hemoglobin of 6.8g/dl in the CBC. [28] Heckenberger et al, [23] analyzing 253 cases of meningococcal meningitis in adults (mean age 36 ± 19 yrs) found a mean serum creatinine of 95mmol/l and sodium of 137mmol/L. Most patients who underwent lumbar puncture (80%, 195 of 242) had counts more than 999 cells in the CSF, with mean of 4.5g protein/l in this series.…”

Section: Discussionmentioning

confidence: 87%

“…Fever, vomiting, headache, stiff neck are the four most common clinical manifestations of MM, [6] as well as in various bacterial meningitis in general. [8,28] Lucena et al, [5] also found, besides these four, seizures lowered level of consciousness and respiratory infection as the most frequent findings in a study involving infants with acute bacterial meningitis.…”

Section: Discussionmentioning

confidence: 91%

Clinical and laboratory aspects of adults and children admitted with meningococcal meningitis to a tertiary hospital in Fortaleza, Ceara, Brazil

Daher

Maia

Ciarlini

et al. 2012

Ann Trop Med Public Health

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Background: Meningococcal meningitis (MM) persists in developing countries in forms of outbreaks, epidemics or sporadic cases, resulting in considerable morbidity and mortality. The aim of this study is to evaluate the clinical and laboratory aspects of adults and children with MM. Materials and Methods: This is a retrospective study with 291 patients diagnosed with MM, hospitalized in a tertiary hospital in Fortaleza, Northeast of Brazil, between 1999 and 2009. We analyzed epidemiological, clinical and laboratory findings. Results: The mean age of patients was 13.7 ± 12.8 years, ranging from newborn to 71 years, 59% were 12 or less, mostly male (57.3%). Average time between symptom onset and hospitalization was 2.21 ± 2.62 days. There was associated meningococcemia at 22.3% of cases. The most common manifestations were fever (92.7%), vomiting (80.4%), headache (68.7%), neck stiffness (64.9%) and petechiae (31.9%). Laboratory tests showed an average Hb 11.1 ± 1.7 g/dL, WBC 17.94 ± 17.29 x 10³/mm³, platelets 20.58 ± 11.53 x 10³/mm³. Sodium (134.66 ± 14.89 mEq/l), potassium (4.2315 ± 3.8805 mEq/l), urea (35.66 ± 35.96 mg/dl), creatinine (0.77 ± 0.77 mg/dl), AST (48.81 ± 62.73 units/L), and ALT (37.93 ± 36.78 units/L) were other laboratory parameters. There was record of 25 deaths (8.5%). Conclusion: Most were children below 12 years, suggesting the vulnerability of this age group for MM. There was no statistical difference between adults and children with regard to laboratorial parameters, but the data show numbers that can represent a laboratory profile of the disease.

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Acute childhood bacterial meningitis in Luanda, Angola

Cited by 17 publications

References 22 publications

Predictors of Bacterial Meningitis in Resource-Limited Contexts: An Angolan Case

Predictors of Bacterial Meningitis in Resource-Limited Contexts: An Angolan Case

Prevalence and antibiotic resistance profiles of cerebrospinal fluid pathogens in children with acute bacterial meningitis in Yunnan province, China, 2012-2015

Clinical and laboratory aspects of adults and children admitted with meningococcal meningitis to a tertiary hospital in Fortaleza, Ceara, Brazil

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