Bacterial meningitis in children in antananarivo, Madagascar

Objective. - To determine the bacterial causal agents of meningitis and their pattern of resistance, in children more than one month to 14 years of age. Methods. - A 2 years, prospective study (June 1998 to June 2000) on bacterial meningitis in children was carried out in the main hospitals in Antananarivo. The enrollment criteria upon admission were fever with symptoms of meningitis and/or convulsions and/or coma. A lumbar puncture was systematically performed in each child. The aspect of the cerebrospinal fluid was described, the level of protein and glucose estimated, soluble antigens measured. Following the examination of a Gram straining, an aliquot of the fluid was cultured on specific medium. Antimicrobial sensitivity testing of isolated pathogens was performed. Results. - Bacterial meningitis was confirmed in 119 children : 95 (80%) and 111 (93%) were less than 12 and 24 months of age, respectively. The sex distribution was 1 : 1. Three predominant microorganisms were identified : Streptococcus pneumoniae (45%), Haemophilus influenzae b (43%) and Neisseria meningitidis (10%) of which ten of 12 cases were belonging to serogroup B. The other microorganisms isolated were E.coli (2%). S. pneumoniae were found to be sensitive to penicilin G and H. influenzae were found to be sensitive to the third generation cephalosporins. Seven percent of the S. pneumoniae strains were mildly resistant (R+I) to chloramphenicol and between 29 and 50 % to aminoglucosides. A moderate resistance against gentamicin and amoxicillin was found in 22-29 % of the H. influenzae strains. The mortality rate was high (3 1 %) and among the surviving children 30% presented with neurosensitive disorders. Conclusion. - According to these data we may recommend the inclusion of vaccination against H. influenzae in the children immunization program in Madagascar. The early diagnosis and treatment with appropriate antibiotics, such as third generation of cephalosporins, are other critical measures to be taken in order to reduce the risk of developing severe complications associated to bacterial meningitis. (C) 2002 Editions scientifiques et medicales Elsevier SAS. All rights reserved.