Bacterial meningitis in a rural Kenyan hospital

In a prospective study to investigate mortality and antibiotic resistance in meningitis patients, thirty two meningitis cases were seen over a three month period. Mean age was 11.3 years (range one month-60 years). Cerebrospinal fluid cultures were positive in 26 patients (81.3%). S.pneumoniae was responsible for 15 cases (46.9%), followed by H.influenzae in seven (21.9%). Salmonella infection was seen in two patients, and E.coli and N.meningitidis in one each. Twelve patients (37.5%) died during hospitalisation with most of the deaths occurring within 48 hours after admission. No patients presented with atypical signs of meningitis. No significant differences were found between delay and outcome. Malaria parasites were found in blood of thirteen patients (41%), but did not contribute to higher mortality. Three of H.influenzae isolates (42.9%) were resistant to ampicillin and penicillin. Reduced sensitivity to penicillin was found in two (13.3%) of S.pneumoniae isolates.     

Bacterial meningitis in the United States in 1995. Active Surveillance Team

BACKGROUND: Before the introduction of the conjugate vaccines, Haemophilus influenzae type b was the major cause of bacterial meningitis in the United States, and meningitis was primarily a disease of infants and young children. We describe the epidemiologic features of bacterial meningitis five years after the H. influenzae type b conjugate vaccines were licensed for routine immunization of infants. METHODS: Data were collected from active, population-based surveillance for culture-confirmed meningitis and other invasive bacterial disease during 1995 in laboratories serving all the acute care hospitals in 22 counties of four states (total population, more than 10 million). The rates were compared with those for 1986 obtained by similar surveillance. RESULTS: On the basis of 248 cases of bacterial meningitis in the surveillance areas, the rates of meningitis (per 100,000) for the major pathogens in 1995 were Streptococcus pneumoniae, 1.1; Neisseria meningitidis, 0.6; group B streptococcus, 0.3; Listeria monocytogenes, 0.2; and H. influenzae, 0.2. Group B streptococcus was the predominant pathogen among newborns, N. meningitidis among children 2 to 18 years old, and S. pneumoniae among adults. Pneumococcal meningitis had the highest case fatality rate (21 percent) and in 36 percent of cases was caused by organisms that were not susceptible to penicillin. From these data, we estimate that 5755 cases of bacterial meningitis were caused by these five pathogens in the United States in 1995, as compared with 12,920 cases in 1986, a reduction of 55 percent. The median age of persons with bacterial meningitis increased greatly, from 15 months in 1986 to 25 years in 1995, largely as a result of a 94 percent reduction in the number of cases of H. influenzae meningitis. CONCLUSIONS: Because of the vaccine-related decline in meningitis due to H. influenzae type b, bacterial meningitis in the United States is now a disease predominantly of adults rather than of infants and young children.     

Bacterial meningitis in the health sector of Virgen del Rocio, Spain

BACKGROUND: The aim of this study was review the epidemiology of the bacterial meningitis in our area. MATERIAL AND METHODS: A retrospective study was carried out of all the cases of bacterial meningitis in children with ages between two months and fourteen years, admitted in our hospital between 1986 and 1997. The following variables we analyzed: Sex, age of the patient, yearly and monthly incidence, previous antibiotic therapy, length of hospital stay, and analytical data of blood and cerebrospinal fluid. RESULTS: In the 755 cases analyzed, the 50% correspond to bacterial meningitis, the 47.6% to viral or aseptic and 2.3% to tuberculous. In of the bacterial meningitis Neisseria meningitidis was isolated in 55.7% of cases, Haemophilus influenzae in 20.4%, Streptococcus pneumoniae in 5.5%, other bacterias in 3.4%, and in 14.5% was not isolated any bacteria. We are assisting to an increase of Neisseria meningitidis serotype C during the last years. Haemophilus influenzae represents a more percentage of bacterial meningitis that in prior years. In meningitis by Streptococcus pneumoniae we observe a clear association with risk factors in children older than 2 years. CONCLUSION: Neisseria meningitidis is the main etiologic agent in children. The vaccination against Haemophilus influenzae serotype b and Neisseria meningitidis A and C can change the epidemiology in next years.     

Bacterial meningitis in emergency medicine. Factors associated with delay of antimicrobial therapy

Each year, Louisiana physicians are called upon to carry out mandatory preparticipation evaluations on more than 70,000 high school athletes and 3,000 college athletes. There have been changes in the guidelines for these evaluations in the state over the last few years. Also, recent state legislation has offered protection for the physicians providing them. This article outlines these changes and provides basic guidelines for the preparticipation evaluation.     

Bacterial meningitis in Swaziland: an 18 month prospective study of its impact

STUDY OBJECTIVE: To describe the epidemiology, clinical features, and outcome of bacterial meningitis in Swaziland. DESIGN: Prospective study of patients diagnosed as having meningitis of nonviral aetiology during an 18 month period from February 1991 to July 1992. SETTING: Four regional hospitals covering the population of the four districts in Swaziland. SUBJECTS: All patients with non-viral meningitis admitted to hospital within the study period. MAIN RESULTS: Altogether 85 patients were reported to have bacterial meningitis: 48.3% were aged under 1 year. Causative organisms were identified in 60% of cases, and Streptococcus pneumoniae was found to be the commonest (49% of cases). Overall, case fatality was 38.8% for all age groups, and 62.5% (15 of 25) for adults. Neurological sequelae occurred in 22.4%. Three of the adult cases were HIV seropositive. Seizures, but not duration of symptoms before admission, were associated with a poor prognosis. There was a significant rise in incidence related to a period of drought. Fifteen patients were reported with tuberculous meningitis, of whom five were known to be HIV seropositive; the case fatality was 73.3%. CONCLUSIONS: The aetiology and age distribution of cases of meningitis differs greatly from that in developed countries. Rising HIV infection may have an important impact on the future incidence of meningitis. The high case mortality found should encourage efforts towards earlier diagnosis and treatment, and strengthens the need to develop appropriate vaccines.     

Bacterial meningitis in children and adults. Changes in community-acquired disease may affect patient care

Despite improved understanding of how bacterial meningitis develops, the infection remains a potentially life-threatening emergency capable of causing significant morbidity and mortality. Since the introduction and widespread use of H influenzae type b vaccine in infancy and childhood in North America, the epidemiology of community-acquired bacterial meningitis has changed. S pneumoniae is now the most common cause in children and adults overall, although N meningitidis causes most disease in patients between ages 2 and 18 years. Broad-spectrum cephalosporins (eg, ceftriaxone, cefotaxime) are considered the agents of choice for empirical treatment of bacterial meningitis. However, use of these agents will have to be reconsidered if the incidence of invasive infection from drug-resistant S pneumoniae continues to increase. The role of adjunctive corticosteroid therapy needs to be better defined. Improved conjugate pneumococcal and meningococcal vaccines may soon make bacterial meningitis a preventable disease.     

Cancer incidence in Alaska natives

A survey of cancer incidence among Alaska Natives for the 5-year period 1969-73 revealed fewer cancer cases overall than expected in relation to US rates, but significantly increased risk for certain cancer sites: the nasopharynx in both sexes (with excesses over 15-fold), the liver in males, and the salivary glands, gallbladder, kidney and thyroid in females. Compared with earlier reports, the observations suggest marked changes in cancer incidence among Alaska Natives over the past two decades, with declines in esophageal and invasive cervical cancers, and increases in cancers of the lung, colon and rectum.     

Bacterial meningitis caused by the strains of Haemophilus influenzae type B resistant to most penicillins and cephalosporins

In recent years bacterial meningitis caused by Haemophilus influenzae appears to have occurred more frequently in Poland. In this paper the author presents three specific cases treated in one typical month at the Department of Neuroinfections at John Paul the II Hospital, Kraków. Each of the cases in question proved difficulty to treat because the strains of bacteria encountered were resistant to the most of penicilins and cephalosporins.     

Airborne hexavalent chromium in southwestern Ontario

This study reports the first field measurements of airborne hexavalent chromium (Cr(vi)) in southwestern Ontario. Hexavalent chromium was identified as an inhalation carcinogen and an air toxic of concern during the 1991-93 Windsor Air Quality Study. The results of that study indicated that approximately 20% of the routinely monitored ambient airborne chromium (Cr) was in the hexavalent form. In addition, the range of carcinogenic health risks attributable to airborne Cr(vi) was determined to be between 1.4 x 10(-5) and 3.0 x 10(-4) for people living in the Windsor area. During the summer of 1993, analyses of concurrent indoor and outdoor 24-hour air quality samples taken at 33 residences in Hamilton resulted in geometric mean Cr(vi) concentrations of 0.20 ng/m3 and 0.55 ng/m3, respectively, and little or no relationship between the indoor and outdoor sample sets. During the summer of 1994, an airborne Cr(vi) size-fraction study was conducted in Hamilton, the results of which suggested that the majority of the Cr(vi) was in the inhalable fraction.     

Performance of Polymer-Modified Asphalt-Aggregate Mixtures in Alaska

Polymer-modified asphalts are used in Alaska to address problems with rutting, cracking, and premature aging. This usage raises two important issues—the improvement of the pavement performance with polymer modification while maintaining the ability to properly place and compact polymer-modified mixes. This study addresses both issues. Base asphalts and polymer-modified binders were analyzed for storage stability, compatibility, and consistency using traditional and Superpave tests. Thermal stress restrained specimen tests and Georgia wheel rutting tests were conducted for asphalt-aggregate mixtures. The test results indicate that polymer-modified asphalts should always be an end result of an extensive product development program. The premanufactured binders had the best performance and workability. The polymer modification improved the performance of all base asphalts in several polymer-asphalt combinations. Some binders smoked excessively during mixing, which warrants further research. A storage stability test should be added to specifications or the contractor should address the storage stability with techniques such as tank circulation. On the basis of the test results, the Superpave PG grading needs to be adjusted for polymer-modified asphalts.     

Occurrence of rabies in wolves of Alaska

We describe a rabies epizootic in northwest Alaska (USA) during 1989 and 1990 which resulted in mortality to several different wolf (Canis lupus) packs. Four radio-collared wolves were confirmed to have rabies while evidence for seven others was strongly suggestive but not confirmed. The wolf population declined during the rabies epizootic; thus rabies may have been a significant limiting factor.