Neonatal Bacterial Meningitis in the Middle Belt of Nigeria

Abstract

SUMMARY A three‐year prospective study of neonatal meningitis in a tertiary hospital in Nigeria was carried out to determine its clinical spectrum and particular characteristics. The 36 infants studied represented a high incidence of 1.9 per 1000 live births, and the infection was significantly higher among lowbirthweight babies. Non‐specific signs and symptoms were common, and temperature instability was a constant finding. Specific neurological manifestations were noted that differed from other reports in the literature and contributed significantly to outcome. The most common aetiological pathogen isolated was Gram‐positive Staphylococcus aureus and the most common Gram‐negative organisms were Klebsiella spp: there was no case of group B streptococci. The pathogens isolated were also at variance with other reports. The mortality rate was 33 per cent and was higher for females. There was no significant difference in outcome between inborn and referred infants, nor between early onset and late onset of the disease. A bulging anterior fontanelle was a significant indicator of poor prognosis. Gentamicin and ceftazidime were the most appropriate antibiotics. RÉSUMÉ Méningítes bactériennes néo‐natales dans la ‘middle‐bell’ du Nigéria Une étude prospective durant trois ans et concernant les méningites néonatales constatees dans un hǒpital tertiaire du Nigéria a été entreprise pour déterminer I'allure clinique et les principales caractéristiques. Les 36 nourrissons examinés traduisaient une incidence élevée de 1.9 cas pour 1OOO naissances vivantes et l'infection est apparue significativement plus elevee parmi les nourrissons de faible poids de naissance. Les signes non spécifiques et les symptǒmes étaient communs et I'instabilite thermique ctait une caracteristique constante. Des manifestations neurologiques spécifiques ont été notees qui differaient de celles d'autres publications et qui contribuaient significativement au devenir. L'etiologie pathogène la plus comrnunement isolee fut le staphylocoque dore parmi les germes gram + et la Klebsiella spp parmi les gram ‐; aucun cas n'etait liéà un streptocoque du groupe B. Les germes isolés étaient égalernent différents de ceux d'autres publications. Le taus de mortalité fut de 33 pour cent, plus éléve chez les filles. II n'a pas été observé de différénce de devenir zntre les nourrissons nes a I'hCApital ou adressés ulterieurement. ni selon un debut precoce ou tardif de I'affection. Une fontanelle antérieure bornbee Sut un indicateur significatif de mauvais pronostic. La gentamicine et la ceftazidime se montrèrent les antibiotiques les plus appropries. ZUSAMMENFASSUNG Neonarale baicterielle Meningitis in Mittelnigeria Es wurde eine prospektive 3‐Jahresstudie über neonatale Meningitis in einem Krankenhaus der dritten Versorgungsstüfe in Nigeria durchgefuhrt, um das klinische Spektrum und die besonderen Charakteristika zu untersuchen. 36 Säuglinge wurden untersucht, das bedeutete eine hohe lnzidenz Von 1.9 pro 1000 Lebendgeburten; die Infek...

Neonatal bacterial meningitis in Tikur Anbessa Specialized Hospital, Ethiopia: a 10-year retrospective review

“…In our study, 29 (52%) neonates with BM had late-onset infection, whereas Chang et al (2000) reported that from 85 patients, 51 (60%) were younger than 7 days old. Similarly, findings documented from Nigeria (Airede et al 2008), Australia (Francis and Gilbert 1992), Trinidad (Ali 1995), Brazil (Luzia et al 2007), Jordan (Daoud et al 1996) and Oxford (Hristeva et al 1993) indicated that low birth weight showed higher risk of neonatal bacterial meningitis and was significantly more likely in the preterm (p < 0.05). There is evidence to suggest that meningitis in preterm low birth weight and sickly babies is caused by organisms, usually from the maternal genital tracts (Delouvois 1994).…”

Systematic review: neonatal meningitis in the developing world

“…1984; Nathoo et al. 1991; Airede 1993; Gebremariam 1998; Campagne 1999; WHO, 1999; Al‐Harthi et al. 2000; Nel 2000; English et al.…”

“…There was significant heterogeneity between study designs, methods and quality. The overwhelming majority of studies were performed in Africa, contributing 14 to the total (Longe et al 1984;Coovadia et al 1989;Haffejee et al 1991;Nathoo et al 1991;Airede 1993;Adhikari et al 1995;Gebremariam 1998;Molyneux et al 1998Molyneux et al , 2006Campagne 1999;Nel 2000;English et al 2003;Laving et al 2003;Milledge et al 2005;Airede et al 2008); there were a single multicentre study (WHO 1999a,b,c), four from the Middle East (Koutouby & Habibullah 1995;Daoud et al 1996;Al-Harthi et al 2000;El-Said et al 2002), two from Latin America (Moreno et al 1994;Ali 1995) and one from Asia (Chotpitayasunondh 1994).…”

Bacterial Meningitis and Deafness in Sub-Saharan Africa

“…Quazy (1996) Airede (2008) The finding of different outcomes in various settings is not uncommon. There are clearly huge differences in terms of population, genetics, and timing of presentation, microbiology and general supportive care which can explain this apparent discrepancy.…”

“…More than 70 per cent of cases are caused by either Streptococcus pneumonia (pneumococcal) or Neisseria meningitides (meningococcal). Haemophius influenza type b (Hib) is responsible for fewer cases in the population as a whole although it is a major problem in children less than 12 months of age, Airede (1993).…”