Etiologies of Bacterial Meningitis in Context of Conflict in Central African Rural Areas

Abstract

Bacterial meningitis is a health problem because of its high frequency and severity. They are endemic and epidemic in the Central African Republic (CAR). The objective of this work was to describe the etiologies of bacterial meningitis in the northern part of the Central African Republic. This was a retrospective descriptive study, conducted at the district hospital in Paoua, covering the period from 1 January 2011 to 30 September 2016. We included in the study, all suspected cases of meningitis (neuro-meningeal and infectious signs) confirmed by isolation of a bacterium from cerebrospinal fluid (CSF) analysis. An anonymous questionnaire collected sociodemographic and biological data that were entered and analyzed with the Epi Info7 software. We included 274 patients whose median age was six years with extremes of 6 months and 54 years. In 75% of the cases, the patients were under 9.5 years old. There were 156 men (56.93%) giving a sex ratio of 1.32. The prevalence of HIV was 4.74% (13/274). Examination of cerebrospinal fluid (CSF) had a turbid appearance in 80.66%, purulent in 7.66%, clear in 6.57%, hematic in 3.65% and xanthochromic in 1.46%. The bacteriological examination revealed the following main germs S. pneumoniae in 51.82%, 40.15% N. meningitidis, H. influenzae 7.30%. We found a case of E. coli (0.36%) and Streptococcus group B (0.36%). On an evolutionary level, the overall lethality was 14.96%. This lethality rate was 20.42% (29/142) for S. pneumoniae, 30% (6/20) for H. influenzae and 5.45% (6/110) for N. meningitidis. In our study, the main causes of bacterial meningitis were S. pneumoniae, N. meningitidis and H. influenzae against which there are effective vaccines. Increasing immunization coverage against these germs may help to reduce the magnitude and severity of these infections.