Post-endemic acute bacterial meningitis in Sudanese children.
The study describes an 18-month surveillance of the epidemiological, clinical and microbiological features of childhood acute bacterial meningitis (ABM) seven months after the end of a major epidemic of Neisseria meningitidis (MC) in Khartoum. A total of 125 children, aged one month to 14 years, who were admitted with a provisional diagnosis of meningitis/meningoencephalitis to the Children's Emergency Hospital (CEH) in Khartoum, Sudan, were prospectively enrolled in the study. Bacterial meningitis was diagnosed by direct microscopy (DM), culture or a recently introduced ELISA assay (EIA-test) in 56 children. Haemophilus influenzae (HI) and MC were the commonest causative bacteria (each accounting for 38%) and were followed by Streptococcus pneumoniae (PNC, 23%). There was a relative decrease in the proportion of HI which was found to be the leading causative bacteria in a previous study done in the same hospital during endemic situations. This was accounted for by a relative excess of MC during the post-epidemic period. Molecular analysis of two MC strains revealed that clone III-I of serogroup A (that caused an intercontinental wave of MC disease between 1983 and 1990) was still prevalent. The case fatality rate was 28.6% which is higher than that reported in Sudan (18.6%) during endemic situations; but comparable to the mortality in other African countries. Of the prognostic factors on admission, low systolic blood pressure (< 70 mmHg), hyperpyrexia (temperature > 40 degrees C) and light to deep coma correlated significantly with a fatal outcome.
Ahmed
A A
AA
University Paediatric Wards, Khartoum Teaching Hospital, Sudan.
Salih
M A
MA
Ahmed
H S
HS
D000208:Acute Disease; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000382:microbiology; D011379:Prognosis; D018571:Sentinel Surveillance; D012703:Serotyping; D013397:Sudan / Q000453:epidemiology