Referral and previous care of children with meningitis in Nigeria: implications for the presentation and outcome of meningitis in developing countries

Akpede, George O.; Omoigberale, AI; Dawodu, Simeon O.; Olomu, Sylvia C.; Shatima, D.; Apeleokha, Matthew

doi:10.1016/j.jns.2004.09.026

Cited by 4 publications

(8 citation statements)

References 20 publications

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“…Our study was restricted to children younger than five years of age, excluding neonates, while the cited studies included neonates and a large review of blood culture sets over several years from routine laboratory practice compared to research settings. In agreement with previous studies, all the microorganisms isolated in this study have been reported as causes of bacterial infection in young children [15,16,20].…”

Section: Discussionsupporting

confidence: 93%

“…This observation agrees with studies from other centres in the country, where rates ranging from 12-39% have been reported [15,[26][27][28][29]. Improving the culture positive rate of CSF in the laboratory has always been very challenging in developing country settings, with several diagnostic difficulties usually contributing factors [10,14,15,28]. We endeavored to deal with some of these challenges with the introduction of Trans-Isolate medium during the course of the study, which however, did not yield an appreciable growth of pathogens from CSF samples.…”

Section: Primary Diagnosissupporting

confidence: 93%

“…The pattern of bacteria isolates reported in this study from CSF is also consistent with what was reported from other centres in the country except that meningococcal meningitis is not common in the southern part of the country where our hospital is located [15,[26][27][28]. Furthermore, the southern parts of Nigeria record only sporadic cases of meningitis compared to the northern parts where epidemic cases of meningitis have occurred in the past [29].…”

Section: Primary Diagnosissupporting

confidence: 89%

“…Furthermore, premature antibiotic use, which is common in the developing countries impact negatively on the efforts of microbiology to isolate the clinically relevant organism and to perform antibiotics susceptibility testing [10]. In a study from Southern regions of Nigeria, referral and previous care in health facilities were significantly associated with delayed presentation, partial treatment, atypical signs, severity of illness and adverse outcome, which are all factors affecting laboratory culture yield of the clinically relevant organism [15]. In our study, 27% of blood cultures yielded bacterial growth, which is low when compared with higher rates of 30-55% reported from children with provisional diagnosis of sepsis in other parts of the country [16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

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Invasive bacteria isolates from children with severe infections in a Nigerian hospital

Onipede

Onayade

Elusiyan

et al. 2009

J Infect Dev Ctries

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Background: Little information is available about the aetiology and epidemiology of serious bacterial infections in Nigeria. This study determined bacterial isolates from blood and cerebrospinal fluid (CSF) of children presenting in the emergency room of a teaching hospital in Nigeria. Method: From October 2005 to December 2006, children aged two to 60 months presenting with signs of acute systemic infections were recruited. Blood culture and CSF specimens were collected and processed using standard microbiological protocols. Data were analysed using SPSS version 11 software. Results: Two hundred and two blood and 69 CSF samples were cultured. Fifty-five (27%) of the blood cultures yielded Gram-negative bacilli and Gram-positive cocci in almost equal proportions. The most common isolates from the blood cultures were Staphylococcus aureus, 26 (12.9%) and atypical coliforms, 13 (6.5%). Others are Klebsiella spp, 3 (1.5%); Klebsiella pneumonia, 2 (1.0%); Escherichia coli, 3 (1.5%); Enterobacter agglomerans, 2 (1.1%); Proteus mirabilis, 2(1%); Pseudomonas spp, 2 (1.0%); Haemophilus influenza, 1 (1.0%); and Coagulase-negative Staphylococcus, 1 (1.0%). Fourteen out of 67 (20.9%) of the CSF samples yielded bacterial isolates: Streptococcus pneumonia, 3 (4.5%); Haemophilus influenza, 8 (11.9%); Hemophilus spp, 1 (1.5%); E. Coli, 1 (1.5%); and atypical coliform, 1 (1.5%). Gram-negative coliform isolates were predominantly resistant to penicillin based antibiotics and co-trimoxazole but sensitive to thirdgeneration cephalosporins and quinolones. A high percentage of S. aureus isolates were multi-drug resistant. Conclusions: Bacterial infections contribute to the significant morbidity among children in our environment. S. aureus was more frequently isolated in sepsis while H. influenzae appears to play a major role in meningitis. Appropriate use of antibiotics is needed to manage affected children effectively. We also recommend improved vaccine coverage of children under the age of five years.

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Section: Discussionsupporting

confidence: 93%

Section: Primary Diagnosissupporting

confidence: 93%

Section: Primary Diagnosissupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Invasive bacteria isolates from children with severe infections in a Nigerian hospital

Onipede

Onayade

Elusiyan

et al. 2009

J Infect Dev Ctries

View full text Add to dashboard Cite

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“…The abysmally poor rate in this study is difficult to explain. Although about 25% of the patients admitted to a history of pre-hospital treatment with antibiotics, and this is likely to be an underestimate bearing in mind previous experiences in the same practice area [80], and partial treatment with antibiotics can markedly reduce the success rates of routine bacteriologic methods of diagnosis [81,82], the poor results of both Gram stain and culture in this study is unusual. Other workers [82] have drawn attention to the challenges in the management of bacterial meningitis in resource-poor settings, among which are those of pre-hospital treatment with antibiotics and limitations in diagnostic resources, and these issues may have worsened.…”

Section: Discussionmentioning

confidence: 85%

Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area

et al. 2017

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BackgroundConvulsions with fever in children are a common neurologic emergency in the tropics, and determining the contribution of endemic viral infections can be challenging. In particular, there is a dearth of data on the prevalence and clinical differentiation of Lassa virus disease (LVD) in febrile children in endemic areas of Nigeria, which has multiple lineages of the virus. The aim of this study was to determine the prevalence and presentation of LVD in febrile children with and without convulsions.Methodology/Principal findingsThis was a prospective study of consecutive febrile children aged ≥1 month– 15 years admitted to the Children’s Emergency Room of Irrua Specialist Teaching Hospital over a period of 1 year. Febrile children with convulsions (Cases) were compared with those without convulsions (Controls). LVD was defined by the presence of a positive Lassa virus RT-PCR test. Rates were compared between groups using χ2 or Fisher’s exact tests and p <0.05 taken as significant. 373 (40.9%) of 913 admissions had fever. Of these, 108/373 (29%) presented with convulsions. The overall prevalence of LVD was 13/373 (3.5%; 95% CI = 1.9%, 5.7%) in febrile admissions, 3/108 (2.8%) in Cases and 10/265 (3.8%) in Controls [(Odds Ratio (95% Confidence Interval) (OR (95% CI)) of LVD in Cases versus Controls = 0.73 (0.2, 2.7)]. Only vomiting (OR (95% CI) = 0.09 (0.01, 0.70)) and bleeding (OR (95% CI) = 39.56 (8.52, 183.7)) were significantly associated with an increased prevalence of LVD.Conclusions/SignificanceLVD is an important cause of fever, including undifferentiated fever in children in endemic areas, but it is not significantly associated with convulsions associated with fever. Its prevalence, and lack of clinical differentiation on presentation, underscores the importance of a high index of suspicion in diagnosis. Screening of febrile children with undifferentiated fever in endemic areas for LVD could be an important medical and public health control measure.

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Central nervous system infection is an important cause of death in underfives hospitalised with World Health Organization (WHO) defined severe and very severe pneumonia

Lupisan

Ruutu

Abucejo-Ladesma

et al. 2007

Vaccine

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Referral and previous care of children with meningitis in Nigeria: implications for the presentation and outcome of meningitis in developing countries

Cited by 4 publications

References 20 publications

Invasive bacteria isolates from children with severe infections in a Nigerian hospital

Invasive bacteria isolates from children with severe infections in a Nigerian hospital

Prevalence of Lassa Virus Disease (LVD) in Nigerian children with fever or fever and convulsions in an endemic area

Central nervous system infection is an important cause of death in underfives hospitalised with World Health Organization (WHO) defined severe and very severe pneumonia

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