TITLE:
Etiologies and Outcome of Children with Purulent Meningitis at the Yaounde Gyneco-Obstetric and Pediatric Hospital (Cameroon)
AUTHORS:
Séraphin Nguefack, Andréas Chiabi, Jacob Enoh, El Hadji Djouberou, Evelyn Mah, Karen Kengne Kamga, Sandra Tatah, Elie Mbonda
KEYWORDS:
Bacterial Meningitis, Etiologies, Outcome, Children, Cameroon
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.4 No.4,
November
17,
2014
ABSTRACT: Background: Bacterial meningitis is
one of the most severe infections in infants and children. It is associated
with high mortality and neurological sequelae. In order to improve the
prognosis of infants and children with purulent meningitis, we decided to
conduct this study whose main objective was to identify the main pathogens
responsible and describe the outcome in infants and children aged 2 months to
15 years admitted for purulent meningitis at the Yaounde Gyneco-Obstetric and
Pediatric Hospital (YGOPH). Method: This was a cross-sectional study with
retrospective data collection and consecutive sampling. Our study was conducted
from 1 January 2009 to 31 December 2013. The patients included in the study
were infants and children aged from 2 months to 15 years who were admitted for
bacterial meningitis at the YGOPH, confirmed by bacteriological examination of
cerebrospinal fluid (CSF) with identification of the pathogen by culture or
soluble antigen. The data was analyzed using SPSS Version 18.0 and Excel 2007.
The Chi-square test was used to determine the association of various variables.
The significance threshold was set as P 0.05. Results: We selected 171 cases
of purulent meningitis who represented 1.54% of admitted patients. The sex
ratio was 1.2. We noted that 45% of our patients were aged 2 months to 1 year.
The main presenting complaints were fever (98.8%), seizures (44.4%) and
vomiting (28.7%). Haemophilus
influenzae was found in 67 children
(39.2%), followed by Streptococcus
pneumoniae in 54 children (31.6%) and Neisseria
meningitidis in 17 children
(9.9%). Acute complications (status epilepticus, coma) were seen in 33% of
patients. The statistically significant (P 0.05) factors for poor prognosis were
aged from 2 months to 1 year (P =
0.0004), coma (P = 0.32), intracranial hypertension (P = 0.0001), the pathogen (P = 0.0032Pneumococcus), a delay
of more than three days between the onset of the disease and the treatment (P = 0.0134) and brain abscess (P = 0.0001). We identified 32 deaths
(18.7%) and 17 cases (9.9%) with neurological sequelae before discharge.
Conclusion: The incidence of acute bacterial meningitis remains high in our
context. The main causes were Haemophilus influenzae, Streptococcus pneumoniae and Neisseria
meningitis. The mortality
rate was high with poor prognosis factors such as age less than 12 months,
delayed care, pneumococcal meningitis, coma, brain abscess, and intracranial
hypertension. Focus should be placed on strengthening the routine immunization
on vaccine-preventable diseases of infants and children against Haemophilus influenzae, Pneumococcus and Meningococcus.