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Laboratory-based surveillance of patients with bacterial meningitis in Egypt (1998–2004)

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Abstract

Laboratory-based surveillance for bacterial meningitis was conducted in a network of infectious disease hospitals in Egypt to better understand the epidemiology of this infection. Healthcare and laboratory personnel were trained in basic surveillance and microbiologic processing of cerebrospinal fluid (CSF) specimens. All bacterial isolates from CSF were confirmed and tested for antimicrobial susceptibility. PCR testing was performed on a random subset of purulent, culture-negative CSF specimens. Of 11,070 patients who met criteria for the case definition, 843 (8%) were culture positive (42% positive for Streptococcus pneumoniae, 20% for Haemophilus influenzae serotype b, 17% for each of Neisseria meningitidis and Mycobacterium tuberculosis, and 6% for other bacteria). Of 1,784 (46%) CSF specimens tested by PCR, 232 (13%) were positive for the first three major pathogens. Of N. meningitidis isolates, 52% belonged to serogroup A, 35% to serogroup B, and 4% to serogroup W135. S. pneumoniae isolates comprised 46 different serotypes, of which 6B, 1, 19A, 23F, and 6A were the most predominant. The overall case-fatality rate for culture-positive cases was 26% and was highest among patients with M. tuberculosis (47%). Factors significantly associated with death (p < 0.05) included admission to rural hospitals, long prodromal period, referral from other hospitals, antibiotic treatment prior to admission, and clear CSF (<100 cells/mm3). Susceptibility to ampicillin and ceftriaxone was observed in 44 and 100% of H. influenzae serotype b isolates and in 52 and 94% of S. pneumoniae isolates, respectively. This surveillance highlights the significant mortality and morbidity associated with bacterial meningitis in Egypt. Decision makers need to review current treatment guidelines and introduce appropriate vaccines for prevention and control of the disease.

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Acknowledgements

We express our sincere appreciation and thanks to the many physicians, nurses, and clinical laboratory staff of the infectious disease hospitals involved in this study. Thanks are extended to the following infectious disease hospital directors: Dr. Yehia Sultan, Dr. Atef Sadaka, Dr. Abdel Halim Abdel Hamid, Dr. Bothaina Bakry, Dr. Mohamed El Ragaby, Dr. Ragaa Sakr, Dr. Mohamed Abdel Hady, Dr. Mofreh Ramzy, Dr. Ahmed Ibrahim, Dr. Said Ibrahim, Dr. Mokhtar Wahba, and Dr. Abdel Fattah Ibrahim. We also thankfully acknowledge support from the staff of the Preventive Sector and the Central Public Health Laboratory of the Ministry of Health and Population who assisted with training and monitoring the activities within the infectious disease hospitals. Appreciation is extended as well to the staff at USAID for their guidance, especially that of Dr. Emad Yanni and Mr. Mark White. We are especially grateful to NAMRU-3 staff members, Mr. Walid William and Mr. Mohamed Abdel Maksoud, and Dr. Maha Talaat for her technical assistance. The present study covers the full surveillance period and all age groups in the population under surveillance. We have published earlier parts of the results from the first 2 years of surveillance in children less than 6 years, because we thought that information was important for decision makers in Egypt who are considering the introduction of Hib vaccine, given the limited data in this country and the whole region. This work was supported by the U.S. Agency for International Development (USAID) and the U.S. Department of Defense Global Emerging Infectious Surveillance System (GEIS) work unit #E022.

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The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or reflecting the views of the U.S. Department of the Navy or the naval service at large, or the Egyptian Ministry of Health and Population.

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Afifi, S., Wasfy, M.O., Azab, M.A. et al. Laboratory-based surveillance of patients with bacterial meningitis in Egypt (1998–2004). Eur J Clin Microbiol Infect Dis 26, 331–340 (2007). https://doi.org/10.1007/s10096-007-0280-x

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