Clinical and Bacteriological Aspects of Purulent Meningitis in Rural Central African Republic

Abstract

Objective:To describe the clinical, bacteriological and evolutionary aspects of purulent meningitis in rural areas in order to obtain data to improve the diagnostic approach.Design: We conducted a retrospective study covering the period from January 1, 2011 to September 30, 2016, in pediatric and internal medicine departments, in a district hospital in northwestern Central African Republic (CAR). We included in the study, patients with febrile meningeal syndrome whose analysis of cerebrospinal fluid (CSF) showed a predominance of neutrophils with or without isolation of a bacterium. Results: A total of 375 patients were included, of which 54.93% of the male, giving a sex-ratio of 1.2. The median age was 4 years [15 days and 75 years]. The main clinical signs were fever (93%), stiff neck (58%), seizures (41.81%) and loss of consciousness (22.67%). In 84.26% of cases, CSF was murky or purulent. The main isolated organisms were S. pneumoniae (51.82%), N. meningitidis (40.15%) and H. influenzae (7.30%). The associated pathologies were malaria (60.53%) and HIV infection (4.27%). The case fatality rate was 14.67%. In 9% of the cases, the patients presented sequelae, essentially neurosensory.Conclusion: Purulent meningitis is common in northern Central Africa, characterized by polymorphic clinical manifestations. Our results suggest that in the event of any febrile episode with meningeal signs, a lumbar puncture should be performed urgently for diagnostic purposes.