The outcome of non-typhoidal salmonella meningitis in Malawian children, 1997-2006.
BACKGROUND
The clinical course and outcome of non-typhoidal salmonella (NTS) meningitis in Malawian children over a 10-year period (1997-2006) is described.


METHODS
Demographic, clinical and laboratory data were collected for all children over 2 months of age admitted with salmonella meningitis to Queen Elizabeth Central Hospital from 1997 to 2006. In the 1st year, salmonellae were susceptible to chloramphenicol, and children received 2 weeks of chloramphenicol treatment. When NTS resistance to chloramphenicol started to appear in 1998, treatment was changed to ceftriaxone. From 2002, the duration of antibiotic therapy was extended to 4-weeks which included 2 weeks of intravenous ceftriaxone and a further 2 weeks of oral ciprofloxacin.


RESULTS
The in-hospital case fatality rate (CFR) was 52.3% (48.2% until 2002 and 53.9% after prolonged antibiotic therapy was introduced). Of the survivors, one in 12 (8.3%) became completely well (sequelae-free) in the period 1997-2001 while 18 of 31 survivors (58.1%) made a complete recovery during 2002-2006 (p<0.01). After the 4-week course of antimicrobial therapy was introduced, the number of relapses or recurrences fell from nine in 15 (60%) survivors treated with chloramphenicol or ceftriaxone to three in 35 (8.7%) survivors who received 4 weeks of antibiotics (p<0.0001).


CONCLUSIONS
In Malawi, salmonella meningitis has a CFR of approximately 50%, which has remained constant over many years. Residual morbidity, however, has decreased over 10 years, despite rising numbers of multi-drug-resistant cases of NTS. This improvement might be owing to better treatment and management and/or reduced pathogenicity of the multi-drug-resistant bacteria.
Molyneux
E M
EM
Department of Paediatrics, College of Medicine, Blantyre, Malawi. emolyneux@malawi.net
Mankhambo
L A
LA
Phiri
Ajib
A
Graham
S M
SM
Forsyth
H
H
Phiri
Amos
A
Walsh
A L
AL
Wilson
L K
LK
Molyneux
M E
ME
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D002701:Chloramphenicol / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D004311:Double-Blind Method; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D007223:Infant; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D012480:Salmonella Infections / Q000188:drug therapy*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D002701:Chloramphenicol; D002443:Ceftriaxone