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Letter
Haemophilus influenzae
Type b Meningitis in Children, Eritrea
Durgadas G. Naik* and Melles Seyoum*
*Central Health Laboratory, Asmara, Eritrea
Suggested citation
for this article:
Naik DG, Seyoum M. Haemophilus influenzae type B meningitis in
children, Eritrea. Emerg Infect Dis [serial online] 2004 Jan [date
cited]. Available from: URL: http://www.cdc.gov/ncidod/EID/vol10no1/03-0132.htm
To the Editor: Bacterial meningitis is a major cause of death
and disability in children worldwide: >1,000,000 cases and 200,000
deaths are estimated to occur each year. Neisseria meningitidis,
Haemophilus influenzae type b (Hib), and Streptococcus pneumoniae
are major causative agents of bacterial meningitis in children. A region
in sub-Saharan Africa, extending from Ethiopia in the east to the Gambia
in the west and containing 15 countries with >260 million people, is
known as the “meningitis belt” because of its high prevalence of endemic
disease with periodic epidemics caused by N. meningitidis.
Eritrea, a small country with an estimated population of 3.5 million
in northeast Africa, is part of the meningitis belt. Eritrea gained independence
in 1993 and borders the Red Sea on the east, Djibouti on the southeast,
Ethiopia on the south, and Sudan on the north. Asmara, with a population
of about 500,000, is the capital city. The estimated infant mortality
rate is 73 deaths/1,000 live births.
In 2002, a prospective laboratory-based study was carried out in Asmara
to gain insight regarding the distribution of bacterial agents causing
bacterial meningitis in children. Starting in January 2002, cerebrospinal
fluid (CSF) specimens were collected from every child who had a spinal
tap administered at Mekane Hiwet Pediatric Hospital, Asmara. This facility
serves as the national reference hospital for pediatric care. Within 1
hour of collection, all CSF specimens were processed at the Department
of Microbiology, Central Health Laboratory. This laboratory, located <200
m from the Mekane Hiwet Pediatric Hospital, serves as the national reference
health laboratory and is the only facility in Eritrea with the capabilities
to perform cultures. Standard methods were used to process all specimens
and to isolate and identify bacterial agents from the CSF specimens (1–3).
All CSF specimens were cultured on chocolate agar plates with IsoVitalex
supplement (BBL Microbiology Systems, Cockeysville, MD) and tested for
bacterial antigens by using Wellcogen latex agglutination kits (Remel,
Inc., Dartford, UK). Hib strain ATCC 49247 was used as the control strain.
All Hib strains were tested for susceptibility to ampicillin, penicillin,
chloramphenicol, gentamicin, and cefotaxime by using the disk diffusion
method (BBL); isolates determined to be penicillin-resistant were also
tested for ß-lactamase by using the Nitrocefin touch sticks (Oxoid, Basingstoke,
UK).
From January 1 to December 31, 2002, a total of 81 CSF specimens were
collected: 38 (47%) were from patients <1 year of age, 28 (35%) from
patients 1 to 2 years of age, and 15 (18%) from patients 2 to 14 years
of age. Twelve (15%) of the 81 specimens tested positive; 10 were positive
by both culture and latex agglutination test (5 Hib, 2 S. pneumoniae,
1 N. meningitidis, and 2 Enterobacteriaceae), and 2 were
positive only by the latex agglutination test (1 Hib and 1 N. meningitidis).
The patients’ age and sex and the results of microbiologic tests are presented
in the Table.
This study preceded the implementation of the Integrated Disease Surveillance
(IDS) in Eritrea (last quarter of 2002) and does not allow for calculation
of incidence of Hib disease at the national level. However, implementation
of IDS will enable microbiologists to prospectively monitor the incidence
of infectious diseases, including meningitis caused by Hib.
In many countries, Hib is still reported as a major cause of bacterial
meningitis (4–9), and while Hib meningitis has a relatively
low case-fatality rate in developed countries (3% to 5%), high case-fatality
rates (20% to 30%) are common in tropical Africa. Rapid laboratory diagnosis
and treatment with appropriate antimicrobial drugs, such as third-generation
cephalosporins, are crucial in reducing the risk for severe complications.
The decrease in Hib meningitis cases after the introduction of Hib vaccination
and the use of vaccine to control Hib meningitis are well documented (10–12).
Additionally, the findings of this study suggest that Hib remains the
leading cause of childhood meningitis in this region and lead us to advocate
for the introduction of vaccination in Eritrea.
References
- Popovic T, Ajello G, Facklam R. Laboratory manual
for the diagnosis of meningitis caused by Neisseria meningitidis,
Streptococcus pneumoniae and Haemophilus influenzae. Document
no. WHO/CDS/CSR/EDC/99.7. Geneva: World Health Organization; 1999.
- Cheesbrough M. Medical laboratory manual for tropical countries, Vol
II. London: Butterworth-Heinemann; 1985. p.160–74.
- National Committee for Clinical Laboratory Standards. Performance
standards for antimicrobial disk susceptibility testing. Approved standard,
7th ed. Document M2-A7. Wayne (PA): The Committee; 2000.
- Uduman SA, Adeyemi E, El-Khadir A, Jose K, Benedict S, Bener A. Haemophilus
influenzae type b still remains a leading cause of meningitis among
unvaccinated children—a prospective CSF analysis study. J Trop Pediatr
2000;46:331–4.
- Limcangco MR, Salole EG, Armour CL. Epidemiology
of Haemophilus influenzae type b meningitis in Manila, Philippines,
1994 to 1996. Pediatr Infect Dis J 2000;19:7–11.
- Lehmann D, Yeka W, Rongap T, Javati A, Saleu G, Clegg A, et al, Aetiology
and clinical signs of bacterial meningitis in children admitted to Goroka
Base Hospital, Papua New Guinea, 1989–1992. Ann Trop Paediatr 1999;19:21–32.
- Sahai S, Mahadevan S, Srinivasan S, Kanungo R. Childhood
bacterial meningitis in Pondicherry, South India. Indian J Pediatr
2001;68:839–41.
- Migliani R, Clouzeau J, Decousser JW, Ravelomanana N, Rasamoelisoa
J, Rabijaona H, et al. Non-tubercular
bacterial meningitis in children in Antananarivo, Madagascar. Arch
Pediatr 2002;9:892–7.
- Matee MI, Matre R. Pathogenic
isolates in meningitis patients in Dar Es Salaam, Tanzania. East
Afr Med J 2001;78:458–60.
- Dickinson FO, Perez AE, Galindo MA. Quintana I. Impact
of vaccination against Haemophilus influenzae type b in Cuba.
Rev Panam Salud Publica 2001;10:169–73.
- Diaz JM, Catalan L, Urrutia MT, Prado V, Ledermann
W, Mendoza C, et al. Trends
of etiology of acute bacterial meningitis in Chilean children from 1989
to 1998. Impact of the anti-H. influenzae type b vaccine.
Rev Med Chil 2001; 129:719–26.
- Peltola H. Worldwide
Haemophilus influenzae type b disease at the beginning of the
21st century: global analysis of the disease burden 25 years after the
use of the polysaccharide vaccine and a decade after the advent of conjugates.
Clin Microbiol Rev 2000;13:302–17.
Table.
Results of microbiologic tests of specimens from five case-patients
with Haemophilus influenzae type ba |
|
Age/sex
|
Latex agglutination test
|
Antimicrobial susceptibility
|
ß-lactamase
|
|
Pen
|
Amp
|
Cefot
|
Chl
|
Genta
|
|
3 months/female
|
Positive
|
R
|
R
|
S
|
S
|
S
|
Positive
|
5 months/male
|
Positive
|
R
|
R
|
S
|
R
|
R
|
Positive
|
6 months/male
|
Positive
|
R
|
R
|
S
|
S
|
S
|
Positive
|
1 year/male
|
Positive
|
R
|
R
|
S
|
S
|
S
|
Positive
|
3 years/male
|
Positive
|
R
|
S
|
S
|
S
|
S
|
Positive
|
|
aPen, penicillin;
Amp, ampicillin; Cefot, cefotaxime; Chl, chloramphenicol; Genta, gentamicin;
S, sensitive; R, resistant. |
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