Case-fatality ratio of bacterial meningitis in the African meningitis belt: we can do better.
In the African meningitis belt, reported case-fatality ratio (CFR) for meningitis are usually calculated on the basis of presumed cases. We reviewed 3509 presumed cases of bacterial meningitis reported in Niger for which a cerebrospinal fluid (CSF) sample had been tested later at the reference laboratory. The main aetiologies were Neisseria meningitidis (1496 cases), Streptococcus pneumoniae (303 cases) and Haemophilus influenzae (105 cases). The CFR of meningococcal meningitis was lower for serogroup A (5.5%) than for serogroups X (12%) and W135 (12.7%). With a CFR of 49.8%, pneumococcal meningitis, albeit representing only 20.7% of confirmed cases, accounted for 50% of the deaths. The disease burden of pneumococcal meningitis must be better taken into consideration in the future. As most treatments are presumptive, there is a urgent need for an easy-to-administer, cheap first-line treatment effective on N. meningitidis as well as on S. pneumoniae and H. influenzae that would replace the single-dose oily chloramphenicol treatment which is the most frequent treatment administered today, independent of microbial aetiology and season. The development of diagnostic tools really suitable for remote health facilities also is an urgent challenge.
Boisier
Pascal
P
Centre de Recherche Médicale et Sanitaire (CERMES), BP 10887, Niamey, Niger. boisier@cermes.org
Maïnassara
Halima Boubacar
HB
Sidikou
Fati
F
Djibo
Saacou
S
Kairo
Kiari Kaka
KK
Chanteau
Suzanne
S
D000293:Adolescent; D000658:Amoxicillin / Q000627:therapeutic use; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002701:Chloramphenicol / Q000627:therapeutic use; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000188:drug therapy* / Q000401:mortality*; D008583:Meningitis, Haemophilus / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000401:mortality; D008585:Meningitis, Meningococcal / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000401:mortality; D008586:Meningitis, Pneumococcal / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000401:mortality; D009345:Neisseria meningitidis / Q000302:isolation & purification; D009548:Niger / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D015996:Survival Rate
D000900:Anti-Bacterial Agents; D002701:Chloramphenicol; D002443:Ceftriaxone; D000667:Ampicillin; D000658:Amoxicillin