Abstract
BackgroundBeside high mortality, acute bacterial meningitis may lead to a high frequency of neuropsychological sequelae. The Sahelian countries belonging to the meningitis belt experience approximately 50% of the meningitis cases occurring in the world. Studies in Africa have shown that N. meningitidis could cause hearing loss in up to 30% of the cases, exceeding sometimes measles. The situation is similar in Niger which experiences yearly meningitis epidemics and where rehabilitation wards are rare and hearing aids remain unaffordable. The aim of this study was to estimate the frequency of neuropsychological sequelae after acute bacterial meningitis in four of the eight regions of Niger.MethodsSubjects exposed to acute bacterial meningitis were enrolled into a cohort with non exposed subjects matched on age and gender. Consenting subjects were interviewed during inclusion and at a control visit two months later. If clinical symptoms or psychological troubles persisted at both visits among the exposed subjects with a frequency significantly greater than that observed among the non exposed subjects, a sequelae was retained. The comparison of the frequency of sequelae between non exposed and exposed subjects to bacterial meningitis was also calculated using the Fisher exact test.ResultsThree persisting functional symptoms were registered: headaches, asthenia, and vertigo among 31.3, 36.9, and 22.4% respectively of the exposed subjects. A significant motor impairment was retrieved among 12.3% of the exposed versus 1.6% of the non exposed subjects. Hearing loss significantly disabled 31.3% of the exposed subjects and 10.4% exhibited a serious deafness.ConclusionsThis study carried out in Niger confirms two serious neurological sequelae occurring at high frequencies after bacterial meningitis: severe and profound hearing loss and motor impairment. Cochlear implantation and hearing aids are too expensive for populations living in developing countries. Neurological sequelae occurring after meningitis should sensitize African public health authorities on the development of rehabilitation centers. All these challenges can be met through existing strategies and guidelines.
Highlights
Beside high mortality, acute bacterial meningitis may lead to a high frequency of neuropsychological sequelae in 3 to 47% of cases, causing 160,000 yearly disabilities worldwide [1,2,3,4,5]
Characteristics of the subjects included Among the 184 subjects who met enrolment criteria, 104 suspected as clinical acute bacterial meningitis were visited and 83 were confirmed as exposed following biological confirmation of acute bacterial meningitis
Symptoms associated with meningitis At inclusion, the 162 subjects recruited in the study consisted of 83 meningitis cases and 79 non exposed subjects
Summary
Acute bacterial meningitis may lead to a high frequency of neuropsychological sequelae. The Sahelian countries belonging to the meningitis belt experience approximately 50% of the meningitis cases occurring in the world. Acute bacterial meningitis may lead to a high frequency of neuropsychological sequelae in 3 to 47% of cases, causing 160,000 yearly disabilities worldwide [1,2,3,4,5]. In 1996, large outbreaks spread across the meningitis belt leading to 250,000 suspected cases and 25,000 deaths [8]. They were mainly due to N. meningitidis serogroup A. Other emerging serogroups of N. meningitidis, such as W135 and X, have been incriminated in recent outbreaks [11,12]
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