Outbreak of serotype W135 Neisseria meningitidis in central river region of the Gambia between February and June 2012: A hospital-based review of Paediatric cases
“…We found additional studies specifically reporting on S pneumoniae (113 studies; 24 553 episodes) (eTable 8 in Supplement 1), N meningitidis (75 studies; 100 278 episodes) (eTable 9 in Supplement 1), H influenzae (49 studies; 28 796 episodes) (eTable 10 in Supplement 1), L monocytogenes (15 studies; 985 episodes) (eTable 11 in Supplement 1),…”
Section: Resultsmentioning
confidence: 99%
“…N meningitidis was among the most frequent pathogens in children and adults (250 studies; 274 study periods; 123 830 episodes) (eTable 16 and eFigure 27 in Supplement 1). This sample was dominated by a Nigerian study describing an outbreak in 2009 with more than 50 000 patients . The overall CFR was 8.8% (95% CI, 8.0% to 9.7%) (eFigure 28 in Supplement 1); CFR was 11% (95% CI, 8% to 16%) before 1961 and 7.2% (95% CI, 5.8.% to 8.7%) i...…”
ImportanceThe impact of vaccination, antibiotics, and anti-inflammatory treatment on pathogen distribution and outcome of bacterial meningitis over the past century is uncertain.ObjectiveTo describe worldwide pathogen distribution and case fatality ratios of community-acquired bacterial meningitis.Data SourcesGoogle Scholar and MEDLINE were searched in January 2022 using the search terms bacterial meningitis and mortality.Study SelectionIncluded studies reported at least 10 patients with bacterial meningitis and survival status. Studies that selected participants by a specific risk factor, had a mean observation period before 1940, or had more than 10% of patients with health care–associated meningitis, tuberculous meningitis, or missing outcome were excluded.Data Extraction and SynthesisData were extracted by 1 author and verified by a second author. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Random-effects models stratified by age (ie, neonates, children, adults), Human Development Index (ie, low-income or high-income countries), and decade and meta-regression using the study period’s year as an estimator variable were used.Main Outcome and MeasureCase fatality ratios of bacterial meningitis.ResultsThis review included 371 studies performed in 108 countries from January 1, 1935, to December 31, 2019, describing 157 656 episodes. Of the 33 295 episodes for which the patients’ sex was reported, 13 452 (40%) occurred in females. Causative pathogens were reported in 104 598 episodes with Neisseria meningitidis in 26 344 (25%) episodes, Streptococcus pneumoniae in 26 035 (25%) episodes, Haemophilus influenzae in 22 722 (22%), other bacteria in 19 161 (18%) episodes, and unidentified pathogen in 10 336 (10%) episodes. The overall case fatality ratio was 18% (95% CI, 16%-19%), decreasing from 32% (95% CI, 24%-40%) before 1961 to 15% (95% CI, 12%-19%) after 2010. It was highest in meningitis caused by Listeria monocytogenes at 27% (95% CI, 24%-31%) and pneumococci at 24% (95% CI, 22%-26%), compared with meningitis caused by meningococci at 9% (95% CI, 8%-10%) or H influenzae at 11% (95% CI, 10%-13%). Meta-regression showed decreasing case fatality ratios overall and stratified by S pneumoniae, Escherichia coli, or Streptococcus agalactiae (P < .001).Conclusions and RelevanceIn this meta-analysis with meta-regression, declining case fatality ratios of community-acquired bacterial meningitis throughout the last century were observed, but a high burden of disease remained.
“…We found additional studies specifically reporting on S pneumoniae (113 studies; 24 553 episodes) (eTable 8 in Supplement 1), N meningitidis (75 studies; 100 278 episodes) (eTable 9 in Supplement 1), H influenzae (49 studies; 28 796 episodes) (eTable 10 in Supplement 1), L monocytogenes (15 studies; 985 episodes) (eTable 11 in Supplement 1),…”
Section: Resultsmentioning
confidence: 99%
“…N meningitidis was among the most frequent pathogens in children and adults (250 studies; 274 study periods; 123 830 episodes) (eTable 16 and eFigure 27 in Supplement 1). This sample was dominated by a Nigerian study describing an outbreak in 2009 with more than 50 000 patients . The overall CFR was 8.8% (95% CI, 8.0% to 9.7%) (eFigure 28 in Supplement 1); CFR was 11% (95% CI, 8% to 16%) before 1961 and 7.2% (95% CI, 5.8.% to 8.7%) i...…”
ImportanceThe impact of vaccination, antibiotics, and anti-inflammatory treatment on pathogen distribution and outcome of bacterial meningitis over the past century is uncertain.ObjectiveTo describe worldwide pathogen distribution and case fatality ratios of community-acquired bacterial meningitis.Data SourcesGoogle Scholar and MEDLINE were searched in January 2022 using the search terms bacterial meningitis and mortality.Study SelectionIncluded studies reported at least 10 patients with bacterial meningitis and survival status. Studies that selected participants by a specific risk factor, had a mean observation period before 1940, or had more than 10% of patients with health care–associated meningitis, tuberculous meningitis, or missing outcome were excluded.Data Extraction and SynthesisData were extracted by 1 author and verified by a second author. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Random-effects models stratified by age (ie, neonates, children, adults), Human Development Index (ie, low-income or high-income countries), and decade and meta-regression using the study period’s year as an estimator variable were used.Main Outcome and MeasureCase fatality ratios of bacterial meningitis.ResultsThis review included 371 studies performed in 108 countries from January 1, 1935, to December 31, 2019, describing 157 656 episodes. Of the 33 295 episodes for which the patients’ sex was reported, 13 452 (40%) occurred in females. Causative pathogens were reported in 104 598 episodes with Neisseria meningitidis in 26 344 (25%) episodes, Streptococcus pneumoniae in 26 035 (25%) episodes, Haemophilus influenzae in 22 722 (22%), other bacteria in 19 161 (18%) episodes, and unidentified pathogen in 10 336 (10%) episodes. The overall case fatality ratio was 18% (95% CI, 16%-19%), decreasing from 32% (95% CI, 24%-40%) before 1961 to 15% (95% CI, 12%-19%) after 2010. It was highest in meningitis caused by Listeria monocytogenes at 27% (95% CI, 24%-31%) and pneumococci at 24% (95% CI, 22%-26%), compared with meningitis caused by meningococci at 9% (95% CI, 8%-10%) or H influenzae at 11% (95% CI, 10%-13%). Meta-regression showed decreasing case fatality ratios overall and stratified by S pneumoniae, Escherichia coli, or Streptococcus agalactiae (P < .001).Conclusions and RelevanceIn this meta-analysis with meta-regression, declining case fatality ratios of community-acquired bacterial meningitis throughout the last century were observed, but a high burden of disease remained.
“…The study designs included (Supplementary Tables S1 and S2): single case ( n = 32) [ 33 – 64 ], cases series (up to 10 cases) ( n = 11) [ 65 – 75 ], hospital-based (including case series with > 10 cases) ( n = 7) [ 76 – 82 ], or surveillance studies ( n = 17) [ 29 – 32 , 83 – 95 ]. Of the hospital-based or surveillance studies, six were prospective [ 77 , 79 , 80 , 86 , 87 ] or included a prospective component [ 83 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“… Proportions shown are based on studies that reported these manifestations and which reported all available IMD cases [i.e., excluding studies that only focused on those with a specific manifestation (e.g., excluding studies that focused on those with meningitis only [ 77 , 86 ])]. Cases reported may have experienced more than one manifestation in some studies.…”
Introduction
Invasive meningococcal disease (IMD) due to serogroup W meningococci (MenW) is consistently reported with atypical clinical manifestations, including gastrointestinal symptoms, bacteremic pneumonia, and septic arthritis. We undertook a systematic review of the literature for a comprehensive assessment of the clinical presentation of IMD caused by MenW.
Methods
PubMed and Embase databases were searched from inception to June 2022 using a combination of MeSH terms and free text for articles that reported symptoms and signs of MenW IMD, and associated manifestations.
Results
The most commonly reported symptoms identified included: fever (range 36–100% of cases), nausea and/or vomiting (range 38–47%), vomiting (range 14–68%), cough (range 7–57%), sore throat (range 13–34%), headache (range 7–50%), diarrhea (range 8–47%), altered consciousness/mental status (range 7–38%), stiff neck (range 7–54%), and nausea (range 7–20%). Sepsis (range 15–83% of cases) was the most commonly reported manifestation followed by meningitis (range 5–72%), sepsis and meningitis (range 6–74%), bacteremic pneumonia (range 4–24%), arthritis (range 1–15%), and other manifestations (e.g., pharyngitis/epiglottitis/supraglottitis/tonsillitis/conjunctivitis; range 1–24%). The case fatality rates ranged from 8–40%, and among the survivors 4–14% had long-term sequelae.
Conclusions
Clinicians need to be aware of the nonspecific symptoms and signs of IMD, as well as of the atypical manifestations in regions where MenW is known to circulate to ensure timely diagnoses and treatment.
Supplementary Information
The online version contains supplementary material available at 10.1007/s40121-023-00869-z.
This article is published with digital features, including a graphical plain language summary, to facilitate understanding of the article. To view digital features for this article go to
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
