Bulging Fontanelle Research Articles

Clinical features of bacterial meningitis among hospitalised children in Kenya

BackgroundDiagnosing bacterial meningitis is essential to optimise the type and duration of antimicrobial therapy to limit mortality and sequelae. In sub-Saharan Africa, many public hospitals lack laboratory capacity, relying on clinical features to empirically treat or not treat meningitis. We investigated whether clinical features of bacterial meningitis identified prior to the introduction of conjugate vaccines still discriminate meningitis in children aged ≥60 days.MethodsWe conducted a retrospective cohort study to validate seven clinical features identified in 2002 (KCH-2002): bulging fontanel, neck stiffness, cyanosis, seizures outside the febrile convulsion age range, focal seizures, impaired consciousness, or fever without malaria parasitaemia and Integrated Management of Childhood Illness (IMCI) signs: neck stiffness, lethargy, impaired consciousness or seizures, and assessed at admission in discriminating bacterial meningitis after the introduction of conjugate vaccines. Children aged ≥60 days hospitalised between 2012 and 2016 at Kilifi County Hospital were included in this analysis. Meningitis was defined as positive cerebrospinal fluid (CSF) culture, organism observed on CSF microscopy, positive CSF antigen test, leukocytes ≥50/μL, or CSF to blood glucose ratio <0.1.ResultsAmong 12,837 admissions, 98 (0.8%) had meningitis. The presence of KCH-2002 signs had a sensitivity of 86% (95% CI 77–92) and specificity of 38% (95% CI 37–38). Exclusion of ‘fever without malaria parasitaemia’ reduced sensitivity to 58% (95% CI 48–68) and increased specificity to 80% (95% CI 79–80). IMCI signs had a sensitivity of 80% (95% CI 70–87) and specificity of 62% (95% CI 61–63).ConclusionsA lower prevalence of bacterial meningitis and less typical signs than in 2002 meant the lower performance of KCH-2002 signs. Clinicians and policymakers should be aware of the number of lumbar punctures (LPs) or empirical treatments needed for each case of meningitis. Establishing basic capacity for CSF analysis is essential to exclude bacterial meningitis in children with potential signs.

Etiology and Risk Factors for Meningitis during an Outbreak in Batié Health District, Burkina Faso, January-March 2016

INTRODUCTION: On 16 March 2016, Batié Health District notified the Burkina Faso Min-istry of Health Surveillance unit of 12 suspected cases of meningitis. During the same period, Batié’s neighboring districts in Côte d´Ivoire and Ghana were experiencing a meningitis epi-demic. We investigated to establish the etiology and risk factors for the disease and to recommend prevention and control measures. METHODS: We conducted unmatched case-control study. A case was any person living in Batié with fever (temp. ? 38.5°C) and any of the following: neck stiffness, neurological disor-der, bulging fontanelle, convulsion during January to April 2016 with cerebrospinal fluid (CSF) positive to PCR. Controls were non sick household members, neighbors or friends to the cases. We analyzed the investigation and laboratory records. We included all confirmed cases and two neighborhood controls per case. We used a standard questionnaire to collect data. We analyzed data by Epi info 7 and calculated odds ratio (ORs),adjusted odds ratios (AOR) and 95% confidence interval. We proceeded to univariate, bivariate, multivariate and logistic re-gression analysis. RESULTS: We interviewed 93 participants including 31 meningitis cases and 62 controls. The median age of cases was 8 years old [2 months-55 years] and 6.5 years old [5 months-51 years] for controls. <i>Streptococcus pneumoniae </i>16(51.61%), <i>Neisseria meningitidis W </i>14(45.16%) and <i>Haemophilus influenzae </i>b 1(3.23%) were the identified germs. The independent risk factors identified were travel to meningitis affected areas (Adjusted odd ra-tio(AOR)=12[2.3-60],p=0.0029); >5 persons sharing bedroom (AOR=5.7[1.5-22],p=0.012) and rhino-pharyngitis (AOR=26[1.8-380],p=0.017).CONCLUSION: Streptococcus pneumoniae and Neisseria meningitidis W caused the out-break in Batié. The risk factors were overcrowding, travel to affected areas, and rhino-pharyngitis. We recommended reactive vaccination against Neisseria meningitidis W, limited travel to affected areas and ventilation of rooms.

Effects of neonatal nutrition interventions on neonatal mortality and child health and development outcomes: A systematic review.

Effects of neonatal nutrition interventions on neonatal mortality and child health and development outcomes: A systematic review.

Transient bulging fontanelle following rotavirus vaccination: A case report

Transient bulging fontanelle is a self-limiting clinical condition characterized by a bulging fontanelle with or without fever, which resolves without medical intervention. It is a relatively uncommon adverse event following immunization. We report a case of an 11 week old, otherwise healthy male infant who presented with a bulging, nontense anterior fontanelle without fever, which developed 11 hours after receiving rotavirus vaccine. Transfontanelle ultrasound scan findings were essentially normal. Two days later, the bulging anterior fontanelle resolved spontaneously. The child had normal neurological development and achieved corresponding developmental milestones over the subsequent eight months of follow-up. This case report highlights the importance of immunization history in the otherwise healthy infant who presents with bulging fontanelle. We recommend that in an otherwise well recently vaccinated infant that presents with bulging anterior fontanelle, lumbar puncture should be deferred while the infant is closely monitored.

Bulging fontanelle in febrile infants as a predictor of bacterial meningitis.

It is common practice to perform a lumbar puncture in infants presenting with fever and a bulging fontanelle in order to rule out bacterial meningitis. However, most of these infants have benign, self-limiting diseases. The objective was to determine whether there is an association between bulging fontanelle and bacterial meningitis in febrile infants. This retrospective cohort study included febrile children with a bulging fontanelle who underwent lumbar puncture at Meir Medical Center from 2005 through 2015. A total of 764 children ages 2-18 months underwent lumbar puncture during the study period. Among them, 304 had a bulging fontanelle and fever on evaluation and cerebrospinal fluid pleocytosis was found in 115 (37.8%), including 1 case of bacterial meningitis (0.3%). None of the infants described on admission as appearing well on presentation was found to have bacterial meningitis. Of the 764 children who underwent lumbar puncture, 10 infants were diagnosed with bacterial meningitis, and only one (10%) presented with a bulging fontanelle.Conclusion: The finding of a bulging fontanelle has very low sensitivity and specificity for bacterial meningitis. Most causes of a bulging fontanelle in febrile infants are self-limiting diseases. The routine approach of performing a lumbar puncture in febrile infants with a bulging fontanelle should be reconsidered. What is Known: • It is common to perform a lumbar puncture in febrile infants with a bulging fontanelle, to rule out bacterial meningitis. • However, there are only few researches regarding the relationship between bulging fontanelle and bacterial meningitis. What is New: • The finding of a bulging fontanelle has very low sensitivity and specificity for bacterial meningitis • The need for routine lumbar puncture in these cases should be reconsidered.

Retrocerebellar Ependymal Cyst Presenting with Obstructive Hydrocephalus in an Infant

AbstractIntracranial ependymal cysts (ECs) are rare benign lesions. They are frequently asymptomatic and arise in the supratentorial regions. Retrocerebellar ECs is a rare location. We present a case of 3-months-old infant who developed obstructive hydrocephalus, bulging fontanel, and macrocephaly secondary to a retrocerebellar EC. Magnetic resonance imaging (MRI) showed a large retrocerebellar cyst that compressed the cerebellum and the brainstem, producing fourth ventricle outlet obstruction and supratentorial hydrocephalus. Microsurgical fenestration of the cyst to the obex of the fourth ventricle and a cystic wall biopsy were performed. The procedure improved supratentorial hydrocephalus, as well as the patient's clinical condition. A histopathological study confirmed the diagnosis of an EC.As far as we know, after a thorough review of the literature, this is the first reported case of retrocerebellar EC. It is a rare cause of hydrocephalus due to outlet obstruction of the fourth ventricle. Treatment of the cause itself was shown to be effective.

Giant Cerebellar Cavernomas in Pediatric Patients: Systematic Review with Illustrative Case

IntroductionGiant cavernomas (GCMs) are angiographically occult vascular malformations of the central nervous system measuring at least 4 cm in diameter. These are rare lesions, especially in the cerebellum. As such, the clinical and radiologic features, surgical management, and outcomes of treatment for this condition are unknown. MethodsWe performed a systematic review of SCOPUS and PubMed databases for case reports and case series of histopathologically proven GCMs arising from the cerebellum in the pediatric population, and included a case managed at our center. Data on clinical presentation, imaging features, surgical treatment and outcomes of management were collected. ResultsA total of 10 cases were identified from the systematic review, including our case report. The patients’ median age was 6 months, with a slight male sex predilection (1.5:1). The most common neurologic manifestations were bulging fontanelle in infants, and headache and focal cerebellar deficits in older children. Surgical excision was done in all cases, while 50% of the cases had CSF diversion surgery done prior to excision. In cases with reported outcome, complete neurologic recovery was achieved in seven while partial recovery was reported in one case. No deaths were reported at median follow-up of 12 months. ConclusionOur case report and systematic review show that giant cerebellar cavernoma is a rare differential diagnosis for symptomatic hemorrhagic cerebellar masses in the pediatric age group. Mainstay of treatment is surgical excision, which can be associated with favorable outcome in most cases.

Clinical features to distinguish meningitis among young infants at a rural Kenyan hospital

BackgroundDetection of meningitis is essential to optimise the duration and choice of antimicrobial agents to limit mortality and sequelae. In low and middle-income countries most health facilities lack laboratory capacity...

Neurological involvement in Kawasaki disease: a retrospective study

BackgroundKawasaki disease (KD) is an acute, self-limiting systemic vasculitis that predominately affects children. Neurological involvement is a known complication of KD, however, its association with KD severity remains elusive. We aimed to systematically describe the general manifestations of neurological involvement in KD, determine whether neurological involvement is a marker of disease severity in patients with KD, and assess the relationship of such involvement with intravenous immunoglobulin (IVIG) resistance and coronary artery lesions (CALs).MethodsWe retrospectively reviewed data from 1582 patients with KD between January 2013 and December 2017. Profiles of patients with neurological symptoms (group A, n = 80) were compared to those of gender- and admission date-matched patients without neurological involvement (group B, n = 512). Multivariate logistic regression analyses were performed to determine whether neurological involvement was significantly associated with IVIG resistance.ResultsNeurological involvement was observed in 5.1% (80/1582) of patients with KD. The neurological manifestations were diffuse, presenting as headache (13/80, 16.3%), convulsions (14/80, 17.5%), somnolence (40/80, 50.1%), extreme irritability (21/80, 26.3%), signs of meningeal irritation (15/80, 18.8%), bulging fontanelles (7/80, 8.8%), and facial palsy (1/80, 1.3%). Neurological symptoms represented the initial and/or predominant manifestation in 47.5% (38/80) of patients with KD. The incidence of IVIG resistance and levels of inflammatory markers were higher in group A than in group B. However, neurological involvement was not an independent risk factor for IVIG resistance or CALs.ConclusionRates of neurological involvement were relatively low in patients with KD. Neurological involvement was associated with an increased risk of IVIG resistance and severe inflammatory burden. Our results highlight the need for pediatricians to recognize KD with neurological involvement and the importance of standard IVIG therapy.Trial registrationRetrospectively registered.

Effect of Synthetic Vitamin A and Probiotics Supplementation for Prevention of Morbidity and Mortality during the Neonatal Period. A Systematic Review and Meta-Analysis of Studies from Low- and Middle-Income Countries.

Background: Suboptimal nutritional status of a newborn is a risk factor for short- and long-term morbidity and mortality. The objectives of this review were to assess the efficacy and effectiveness of neonatal synthetic vitamin A supplementation, dextrose gel and probiotic supplementation for prevention of morbidity and mortality during infancy in low and middle-income countries. Methods: We included randomized trials. Primary outcome was all-cause mortality. We conducted electronic searches on multiple databases. Data were meta-analyzed to obtain relative risk (RR) and 95% confidence interval (CI). Studies for vitamin A and Probiotics were analyzed separately. No studies were found for dextrose gel supplementation during neonatal period. The overall rating of evidence was determined by Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: Sixteen studies assessed the effect of vitamin A supplementation during the neonatal period. Based on pooled data from community-based studies only, there was no significant effect of vitamin A on all-cause mortality at age 1 month (RR 0.99, 95% CI 0.90, 1.08), 6 months (RR 0.98; 95% CI 0.89–1.08) and 12 months (RR 1.04, 95% CI 0.94, 1.14) but increased risk of bulging fontanelle (RR 1.53, 95% CI 1.12, 2.09). The overall quality of evidence was high for the above outcomes. Thirty-three studies assessed the effect of probiotic supplementation during the neonatal period and were mostly conducted in the hospital setting. Probiotics reduced the risk of all-cause mortality (RR 0.80, 95% CI 0.66, 0.96), necrotizing enterocolitis (RR 0.46, 95% CI 0.35, 0.59) and neonatal sepsis (RR 0.78, 95% CI 0.70, 0.86). The grade ratings for the above three outcomes were high. Conclusions: Vitamin A supplementation during the neonatal period does not reduce all-cause neonatal or infant mortality in low and middle-income countries in the community setting. Probiotic supplementation during the neonatal period seems to reduce all-cause mortality, NEC, and sepsis in babies born low birth weight and/or preterm in the hospital setting.

The predictors of acute bacterial meningitis among children presenting as first complex febrile seizure

The association between febrile seizure and bacterial meningitis is well established. Although FS induced by age related hyper-excitability of the brain to fever, determining the cause of the fever is critical in the evaluation of these children. It is therefore imperative to rule out BM prior to making the diagnosis of FS. However, the diagnosis of FS in certain subgroups of children with an apparent FS is a challenge: It is mandatory to look for signs of raised intracranial pressure i.e. bulging fontanel, papilloedema and signs of meningeal irritation to exclude meningitis. After approval from the institutional ethics committee, the study was initiated. The parents of children admitted to our institute who were fulfilling the inclusion criteria were informed about this study. Only those patients presenting as first complex febrile seizures are included in the study. Written informed consent from the parents of patients admitted in paediatric wards of Post Graduate Institute of Paediatric Sciences were taken. All cases of ABM had positive CRP compared to the 19% (n=22) cases without bacterial meningitis had positive CRP. Out of total 125 cases, 96.8% (n=122) had negative blood culture, 3.2% (n=4) had positive blood cultures and the blood culture was positive in 3 (33.3%) of ABM cases and 1 (0.8%) with NO ABM. This difference between positive blood culture and ABM was statistically significant.

Bacterial meningitis in Sudanese children; critical evaluation of the clinical decision using clinical prediction rules

BackgroundSudan falls in the meningitis belt where most global cases of bacterial meningitis are reported. Highly accurate decision support tools have been developed by international specialized societies to guide the diagnosis and limit unnecessary hospital admissions and prolonged antibiotic use that have been frequently reported from countries around the world. The goals of this study are to critically evaluate the clinical decision of bacterial meningitis in children in Sudan using clinical prediction rules and to identify the current bacterial aetiology.MethodsThis cross-sectional hospital-based study was conducted in October to July of 2010 in a major referral pediatric hospital in Khartoum, Sudan. Febrile children age 1 day to 15 years who were provisionally diagnosed as having meningitis on admission were included (n = 503). Cerebrospinal fluid (CSF) specimens were obtained from all patients while clinical and demographic data were available for only 404. Conventional laboratory investigations were performed. The clinical decision was evaluated by the International Classification of Diseases–Clinical Modification code 320.9 and the Bacterial Meningitis Score. Ethical clearance and permissions were obtained.ResultsOut of 503 provisionally diagnosed bacterial meningitis patients, the final clinical confirmation was assigned to 55.9%. When codes were applied; 5.7% (23/404) with CSF pleocytosis were re-classified as High Risk for bacterial meningitis and 1.5% (6/404) with confirmed bacterial aetiology as Proven Bacterial Meningitis. Neisseria meningitidis was identified in 0.7% (3/404) and Streptococcus pneumoniae in another 0.7%. Typical laboratory findings (i.e. CSF pleocytosis and/or low glucose and high protein concentrations, Gram positive or Gram negative diplococcic, positive bacterial culture) were seen in 5 (83%). Clinically, patients showed fever, seizures, chills, headache, vomiting, stiff neck and bulging fontanelle. All confirmed cases were less than 5 years old and were admitted in summer. All patients were prescribed with antibiotics; they were all recovered and discharged.ConclusionsBacterial meningitis is over-diagnosed in hospitals in Khartoum therefore clinical prediction rules must be adopted and applied to guide the clinical decision. The sole bacterial aetiology in this selected group of Sudanese children remain N. meningitidis and S. pneumoniae, but with significant decrease in prevalence. Some cases showed atypical clinical and laboratory findings.

P.074 Infantile idiopathic intracranial hypertension - a case study and review of the literature

Background: Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is an increase in intracranial pressure due to unknown etiology. Presentation in infancy is extremely rare. Little is known about infantile IIH and age-specific treatment guidelines are lacking. Methods: Patient data was obtained from medical records at the Children’s Hospital of Eastern Ontario. A literature review of infantile IIH was performed. Results: A previously healthy 9-month-old boy presented with irritability, decreased appetite, and a bulging fontanelle. CT head imaging and cerebrospinal fluid studies revealed normal results. Symptoms transiently resolved after a lumbar puncture, but 11 days later, his fontanelle bulged again. A second lumbar puncture revealed an elevated opening pressure of 35 cm H2O and led to a diagnosis of IIH in accordance with the modified Dandy Criteria. Treatment with acetazolamide at a dose of 25 mg/kg/day was initiated and the patient remained symptom-free for 6 weeks, followed by another relapse. His acetazolamide was increased to 38 mg/kg/day, with no further relapses to date. Conclusions: A diagnosis of IIH is challenging in infants, since the patients cannot yet verbalize typical IIH-related symptoms, and papilledema is difficult to assess. If undetected and untreated, IIH may result in permanent visual deficits.

Clinical and Head Ultrasound Findings in Neonates after Administration of High Dose of Vitamin A

Vitamin A deficiency is a major cause of blindness and severe morbidity and mortality in young children. Supplementation of vitamin A in the community might reduce child mortality rates. The safety of high dose of vitamin A administered to neonates is not clear. We randomized 2058 neonates to receive either a single dose of 50 000 IU oral vitamin A (n=l031) or placebo (n=l027). Bulging fontanel and head circumference were assessed before and throughout 48 hours following dosing. Cranial ultrasound examination was carried out in 972 infants before and 24 hours after dosing to rule out intracranial hemorrhage and determine resistive index (Rl) of the anterior cerebral artery. Slight bulging fontanel occurred in 2. 7% and 4.4% of the infants at 24 hours. Moderate bulging fontanel was seen in 0.1% of study group, no severe bulging was observed. At 48 hours slight bulging fontanel was observed in 2.4% of control group and 4.5% in study group. No intracranial hemorrhage was found. Mean RI values were normal in both groups at baseline or 24 hours. Bulging fontanel was not associated with increased signs or symptom, or with increase in RI. Single oral dose of 50 000 vitamin A may cause a small increase in intracranial volume in a small proportion of infants, without increase in intracranial pressure.

Recurrent fever, bulging fontanelle and elevated white blood cell

This patient presented with fever, seizure and bulging fontanelle when he was 6-month-old.According to the investigations, white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) increased significantly, and Streptococcus Pneumonia grew in both blood and cerebrospinal fluid (CSF). He responded to standard antibiotic treatment poorly even it lasted long enough.At the same time, the inflammation seemed to be over-activated, the WBC level was still elevated, high fever continued.Thus they thought of primary immunodeficiency and sent blood sample for gene panel testing (Sanger sequencing) but got negative result.At last, they added steroid together with anti-tuberculosis drug therapy, his temperature as well as the intracranial pressure became better ever since.At the age of 1 year and 1 month, he got another Streptococcus Pneumonia meningitis, while he was still on anti-tuberculosis drug therapy and tapering off steroid.At this time, he presented with coarse hair, hypohidrosis and delayed eruption of teeth, which strongly indicated Anhidrotic Ectodermal Dysplasia with Immunodeficiency (EDA-ID). NEMO is the most common gene responsible for EDA-ID and locates on X chromosome.It has a pseudogene named IKBKGP which locates downstream of NEMO. IKBKGP and NEMO share 3-10 exons with the homology of 99.8%, which makes it difficult to find out most real mutations within NEMO with Sanger sequencing.Then they performed PCR with the primer starting upstream of the shared exons.Finally, they found out the pathogenic mutation [c.505G>C(p.A169P)] of NEMO, which has been reported.This finding led us to make the right diagnosis as well as the proper treatment and the prognosis for this patient. Key words: Recurrent infection; Streptococcus Pneumonia meningitis; Primary immunodeficiency; Anhidrotic ectodermal dysplasia with immunodeficiency

Predictors of Primary Intracranial Hypertension in Children Using a Newly Suggested Opening Pressure Cutoff of 280 mm H2O

ObjectivesWe assessed the clinical characteristics of primary intracranial hypertension (PIH) in children using a newly recommended threshold for cerebrospinal fluid opening pressure (280 mm H2O). MethodCross-sectional study of patients age ≤21 years who had a lumbar puncture done for evaluation of PIH. Patients were excluded if lumbar puncture was done for a suspected infection, seizure, mental status changes, multiple sclerosis, or Guillain-Barre syndrome. Cases were identified using a text-search module followed by manual review. We performed χ2 analysis for categorical data and Mann-Whitney U test for continuous data, followed by a binary logistic regression. ResultsWe identified 374 patients of whom 67% were female, median age was 13 years interquartile range (11 to 16 years), and admission rate was 24%. Using an opening pressure cutoff of 250 mm H2O, 127 patients (34%) were identified as having PIH, whereas using the new cutoff 105 patients (28%) met PIH criteria. Predictors for PIH included optic disc edema or sixth nerve palsy using both old, odds ratio (OR) 7.6 (4.3, 13.5), and new cutoffs, OR 9.7 (95% confidence interval 5.1, 18.5). Headache duration ≤61 days is predictive of PIH using the new cutoff OR 4.1 (95% confidence interval 1.3, 12.8). A model is presented which stratifies patients into groups with low (7%), medium (18%), and high (greater than 42%) risk of PIH. ConclusionsA higher cerebrospinal fluid opening pressure threshold in the criteria of PIH is associated with PIH patients with a different symptom profile. Children with optic disc edema, bulging fontanel or sixth nerve palsy, are at increased risk for PIH.

Clinical Characteristics and Risk Factors for Poor Outcome in Infants Less Than 90 Days of Age With Bacterial Meningitis in the United Kingdom and Ireland.

To describe the clinical characteristics and risk factors associated with poor outcome in infants <90 days of age with bacterial meningitis. Prospective, enhanced, national population-based active surveillance for infants <90 days of age with bacterial meningitis in the United Kingdom and Ireland between July 2010 and July 2011. Infants were identified through the British Paediatric Surveillance Unit, laboratory surveillance and meningitis charities. Clinical details was available for 263 of 298 (88%) infants where a bacterium was identified, 184 (70%) were born at term. Fever was reported in 143 (54%), seizures in 73 (28%), bulging fontanelle in 58 (22%), coma in 15 (6%) and neck stiffness in 7 (3%). Twenty-three (9%) died and 56/240 (23%) of the survivors had serious central nervous system complications at discharge. Temperature instability [odds ratio (OR), 2.99; 95% confidence interval (CI): 1.21-7.41], seizures (OR, 7.06; 95% CI: 2.80-17.81), cerebrospinal fluid protein greater than the median concentration (2275 mg/dL; OR, 2.62; 95% CI: 1.13-6.10) and pneumococcal meningitis (OR, 4.83; 95% CI: 1.33-17.58) were independently associated with serious central nervous system complications while prematurity (OR, 5.84; 95% CI: 2.02-16.85), low birthweight (OR, 8.48; 95% CI: 2.60-27.69), coma at presentation (OR, 31.85; 95% CI: 8.46-119.81) and pneumococcal meningitis (OR, 4.62; 95% CI: 1.19-17.91) were independently associated with death. The classic features of meningitis were uncommon. The presentation in young infants is often nonspecific, and only half of cases presented with fever. A number of clinical and laboratory factors were associated with poor outcomes; further research is required to determine how knowledge of these risk factors might improve clinical management and outcomes.

Cerebrospinal Meningitis Outbreak in Zamfara State, North–West Nigeria, December, 2016–June, 2017

Background: Meningitis is an acute severe infection of central nervous system associated with significant morbidity and mortality. Neisseria meningitides is the main cause of meningitis epidemics in the African region. An outbreak of meningitis was confirmed in Zamfara State and five other states in the Northern part of Nigeria. We were deployed to Zamfara State to support the state health officials to control the outbreak. We described the outbreak, strengthened surveillance, improved laboratory testing and managed data which informed decision making. Methods & Materials: We conducted active case search in health facilities and communities, obtained daily line–list of suspected cases (any person with fever and one of the following: neck stiffness, altered consciousness, bulging fontanelle in toddlers) from all 14 Local Government Areas (LGAs) surveillance officers. Line–lists were cleaned, merged and updated daily. We performed univariate analysis to determine rates, frequencies and proportion. Cerebrospinal fluids (CSF) were collected from suspected cases and were tested using Pastorex kits and culture. Results: A total of 7,035 suspected cases and 536 deaths (case fatality rate: 7.6%) were reported. 3522 (50.1%) were females and modal age group was 1–10 years old 2975 (42.3%). Shinkafi LGA was the worst hit with an attack rate of 663/100,000. Epidemic threshold for the state was reached in epidemiological week 12–17 and peaked at week 14. Out of 233 CSF samples sent for laboratory testing, 109 (46.8%) tested positive for Neisseria meningitides, 103 (94%) of which is serogroup C. Conclusion: The outbreak affected mostly the younger age group and was predominantly caused by Neiserria meningitides serogroup C

Pneumococcal meningitis outbreak and associated factors in six districts of Brong Ahafo region, Ghana, 2016

BackgroundMeningitis, a disease of the Central Nervous System is described as inflammation of the covering of the brain and spinal cord (meninges). It is characterised by fever, severe headache, nausea, vomiting, stiff neck, photophobia, altered consciousness, convulsion/seizures and coma. In December, 2015, twelve suspected cases of meningitis were reported in Tain district in Brong Ahafo region (BAR). Subsequently, dozens of suspected cases were hospitalized in five district hospitals in BAR. We investigated to determine the magnitude, causative agent and risk factors for the disease transmission.MethodsA community-based 1:2 case-control study (with 126 individuals) was conducted form 10/12/15 to 26/4/16 in 27 districts of Brong-Ahafo Region, Ghana. We defined suspected meningitis cases as people presenting with sudden headache and fevers (Temp> 38.0 °C) in combination with one of the following signs: neck stiffness, altered consciousness, convulsions, bulging fontanelle (infants) and other meningeal signs. Controls were selected from the same neighbourhood and defined as individuals with no overt meningitis signs/symptoms. We collected CSF samples and performed serological testing using Pastorex-Meningitis-Kit and culture for bacterial isolation. Moreover, structured questionnaires were used to collect data on socio-demographics, living conditions, health status and other risk factors. We conducted univariate data analysis and logistic regressions to study disease-exposure associations using Stata 15.ResultsA total of 969 suspected cases with 85 deaths (CFR = 9.0%) were recorded between December, 2015 and March, 2016. Majority, 55.9% (542/969) were females aged between 10 months-74 years (median 20 years, IQR; 14-34). Of the 969 cases, 141 were confirmed by Laboratory test with Streptococcus pneumoniae identified as the causative agent. Cases were reported in 20 districts but 6 of these districts reported cases above threshold levels. The outbreak peaked in week 6 with 178 cases. Overall attack rate (AR) was 235.0/100,000 population. District specific ARs were; Tain; 143.6/100,000, Wenchi; 110.0/100,000, Techiman; 46.6/100,000, Jaman North; 382.3/100,000 and Nkoranza South; 86.4/100,000. Female and male specific ARs were 251.3/100,000 and 214.5/100,000 respectively. Age group 10-19 years were most affected 33.8% (317/940). We identified sore throat [aOR = 5.2, 95% (CI 1.1-26.1)] and alcohol use [aOR = 9.1, 95%(CI 1.4-55.7)] as factors associated with the disease transmission.ConclusionMeningitis outbreak due to Streptococcus pneumoniae was established in BAR. Upper respiratory tract infection and alcohol use were associated with the outbreak. Mass campaigns on healthy living habits, signs and symptoms of meningitis as well as the need for early reporting were some of the control measures instituted. Moreover, we recommend Pneumococcal vaccination in BAR to prevent future outbreaks.

Abstract P-199: THE FIRST SUCCESSFUL EXPERIENCE IN THE BALTIC COUNTRIES USING A CARPEDIEM DIALYSIS MACHINE IN A SEPTIC SHOCK PATIENT

Aims & Objectives: Invasive meningococcal infection (IMI) is one of the most devastating infections with challenging recognition, high fatality rate, long-term sequelae. One of the most common sequelae is acute kidney failure (AKF). Peritoneal dialysis remains the gold standard for managing AKF, although treatment effect can be limited due to patient’s low weight. The aim was to describe appliance of a Carpediem (Cardio-Renal Pediatric Dialysis Emergency Machine) in treatment of AKF in a low weight patient. Methods Clinical data of a case report was retrieved from Vilnius University Children’s Hospital database. Results A 16-month old male patient with a weight of 9 kilograms was admitted to PICU 15 hours after disease onset. A patient presented with spreading hemorrhagic lesions, clonic seizures, bulging fontanel, cardiopulmonary insufficiency and acute kidney failure. Metabolic acidosis with hyperlactatemia, uremia and compromised blood coagulation were found. Mechanical ventilation was started together with fluid therapy, vasoactive drugs and ceftriaxone. Due to progression of AKF a slow continuous ultrafiltration (SCUF) using Carpediem was initiated 18 hours after anuria onset with fluid overload of 590 ml in the past 29 hours. 3 days after SCUF was replaced with peritoneal dialysis. Despite of high IMI fatality rate, a patient’s condition improved and kidney function restored in 10 days, whereas in first 43 hours of renal replacement therapy 1270 ml of ultrafiltrate was removed. A patient was discharged from the hospital 3 months after without signs of AKF. Conclusions SCUF using a Carpediem machine in a low weight patient was effective and promising in AKF treatment.