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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
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for the diagnosis of meningitis caused by Neisseria meningitidis,
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| Table.
Results of microbiologic tests of specimens from five case-patients
with Haemophilus influenzae type ba |
|
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Age/sex
|
Latex agglutination test
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Antimicrobial susceptibility
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ß-lactamase
|
|
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Pen
|
Amp
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Cefot
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Chl
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Genta
|
|
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3 months/female
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Positive
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R
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R
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S
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S
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S
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Positive
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5 months/male
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Positive
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R
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R
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S
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R
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R
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Positive
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6 months/male
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Positive
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R
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R
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S
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S
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S
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Positive
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1 year/male
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Positive
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R
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R
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S
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S
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S
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Positive
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3 years/male
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Positive
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R
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S
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S
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S
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S
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Positive
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| aPen, penicillin;
Amp, ampicillin; Cefot, cefotaxime; Chl, chloramphenicol; Genta, gentamicin;
S, sensitive; R, resistant. |
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