Cases Of Cerebrospinal Meningitis Research Articles

Trends in Neisseria meningitidis serogroups amongst patients with suspected cerebrospinal meningitis in the meningitis belt of Ghana: a 5-year retrospective study

BackgroundSerogroup A Neisseria meningitidis was the major cause of meningococcal meningitis epidemics in the African meningitis belt before 2010 when the monovalent meningococcal A conjugate vaccine (MenAfriVac) was introduced in the region. Therefore, this study aimed to establish the trends in N. meningitidis serogroups from 2016 to 2020 in Ghana’s meningitis belt.MethodsPolymerase chain reaction (PCR) confirmed laboratory results of suspected cases of cerebrospinal meningitis from January, 2016 to March, 2020 were obtained from the Tamale Public Health Laboratory. The data were subjected to trend analysis using Statistical Package for the Social Sciences version 25. Differences between discrete variables were analyzed using the Cochran–Armitage trend test.ResultsOf the 2,426 suspected cases, 395 (16.3%) were confirmed positive for N. meningitidis using PCR. Serogroup X showed a significant upward trend (P < 0.01), and serogroup W showed a downward trend (P < 0.01). However, no significant trend was observed for any other serogroup.ConclusionThis study showed the emergence of serogroup X, a non-vaccine type, as the predominant N. meningitidis serogroup in the wake of a declining serogroup W in Ghana’s meningitis belt.

Effect of climate change on cerebrospinal meningitis morbidities and mortalities: A longitudinal and community-based study in Ghana

Cerebrospinal Meningitis (CSM) is one of the climate-sensitive diseases affected by global climate change. Its causal agent, Neisseria meningitidis bacterial, thrives well in warm environments. CSM epidemics are likely to be exacerbated by the warming globe emanating from climate change. Yet studies have rarely examined the association between climat’e change and CSM. Moreover, studies drawing on quantitative and qualitative data to understand the pathways of climate change domains and CSM relationships as well as community perspectives of CSM are rare. This study deployed mixed-method research to analyse community perceptions of and the relationship between climate change and CSM. We collected 96 months of data on changes in metrological weather parameters (temperatures, sunshine, relative and absolute humidity, and rainfall) and CSM cases and mortalities recorded between 2012 and 2019. Community-level data were elicited using a semi-structured questionnaire. The results showed a statistically significant relationship between climate variables and CSM. High temperatures and sunshine, low rainfall, low relative and absolute humidity were significantly associated with CSM outbreaks. Community participants demonstrated fair knowledge about CSM and attributed its outbreak to climate change. The respondents asserted that the symptoms of CSM, such as severe headache, high fever, stiff neck and waist pains, among others, are often prevalent in their communities when there is high temperature, low relative and absolute humidity, excessive sunshine and dusty winds (harmattan winds). They also revealed that poor environmental sanitation, poor room ventilation, overcrowding in a room, and social integration such as festivals, markets, and religious activities, among others, can exacerbate the outbreak of CSM. We recommend awareness campaign in the communities on the need to ensure proper ventilation in their homes and workplaces, keep their surroundings clean and preserve the econ-system to reduce high temperatures.

A retrospective evaluation of cerebrospinal meningitis data in upper West Region, Ghana, 2015-2021

Cerebrospinal meningitis (CSM) is a disease of public health concern for countries within the Sahel region and Ghana. The upper west region has been recording CSM cases over the years. This study seeks to generate evidence using CSM data from the region so as to make recommendations to improve surveillance. To establish evidence to improve surveillance, we pooled CSM surveillance dataset from 2015 to 2021 for all the 11 districts/municipals in the region. The study employed retrospective descriptive cross-sectional review design using both univariate and bivariate analysis. A total of 2,066 cases within the study period were reported. Out of these cases, 50.82% (1,050/2,066) were males while the remaining 49.18% were females. The proportion of reported cases aged 0 to 29 years was 65.34%. The Overall Case Fatality Rate (CFR) was 10.8% (233/2,066). In all, 74% of the cases were recorded between January to April. Laboratory confirmed cases were 18% and 16.98% (X2 = 18.69; P < 0.000) of these Laboratory-confirmed cases died. Also, 8% of the cases that were negative and 10% of laboratory suspected cases died. Most CSM cases were recorded in the dry season with majority of the victims being persons younger than 30 years. Almost a quarter of the cases were laboratory confirmed and the most recent year witness a decline in both morbidity and mortality rates. There is need to take note of these trends and intensify CSM surveillance so as to improve on the laboratory confirmed cases.

Characteristics of Cerebrospinal Meningitis Cases in 2017 Outbreak, Sokoto State, Nigeria: A Secondary Data Analysis

Introduction: Cerebro-Spinal Meningitis (CSM) is an acute illness affecting surrounding layers of the brain and spinal cord, mostly caused by bacterial infection. The disease is responsible for the occurrence of epidemic meningitis in the African Meningitic belt. For many years, this region has experienced a large serogroup A epidemic every 7-10 years. A sharp decrease in the number of reported cases was demonstrated in countries where Men Afrivac has been introduced. However, serogroup replacement with serotype C was noted in the region, which has posed a serious threat to eliminating CSM epidemics. We describe the characteristics of cerebrospinal meningitis cases in the 2017 outbreak in Sokoto state, Nigeria.&#x0D; Methodology: We obtained CSM data from the state epidemiology unit from 7th February to 24th May 2017. We extracted data on demographic characteristics, clinical features, case management and outcome of cases. We used Microsoft Excel and SPSS to analyze the data for proportions, cross-tabulations and chi-square test to find associations between variables.&#x0D; Results: A total of 4969 CSM cases were recorded, with 283 deaths (case fatality rate: 5.7%). The cumulative attack rate was 96.4/ 100,000 populations. The highest proportion of cases was among ≥ the 15-year age group 2063(41.5%), and males were more affected, 2843(57.2%). Of the total 4969 suspected CSM cases, specimens were collected for only 225 (4.4%) cases, of which 58 (25.8%) were positive. Most 48 (82.8%) of the positive specimen were of NmC serotype. Only age was found to predict outcome (aOR: 1.52; 95% CI= 1.18 – 1.97).&#x0D; Conclusion: Sokoto State outbreak of Cerebro-spinal meningitis in 2017 was huge and largely caused by NmC. Those aged less than 15 years might be at higher risk of dying from CSM and we therefore recommend that specific preventive interventions such as vaccination and awareness creation should target this age group.

Etiology Agents and Antibiotic Susceptibility profile of Cerebrospinal Meningitis: Retrospective Description of Surveillance Data in Rwanda

Background: Cerebrospinal meningitis is an important cause of morbidity and mortality globally, but its highest burden is in sub-Saharan Africa. Surveillance is critical to assess the burden of the disease and provide the necessary information to mitigate the impact. The aim of this study is to assess the cases of Cerebrospinal meningitis occurring across the Rwanda in order to determine where the burden of illness lies, the causative agents and effective treatments.Method: A retrospective study was carried out from January 2010 to December 2016. 173 cerebrospinal fluid samples from 25 Districts Hospitals in Rwanda were collected from patients suspected of meningitis. Demographic characteristics, region and season, etiological agents, antimicrobial susceptibility variables were analyzed with SPSS, version 22.Results: Out of 173 suspected cases, 68 were positive for cerebrospinal meningitis. Of the positive cases 35 (56.1% were male) and 17 (25%) were under 5 years of age. The majority of cases 27 (37.5%) occurred between June and September and 22 (32%) were found in the eastern region. In this sample 32 (47.1%) of the confirmed cases were caused by Streptococcus pneumonia, followed by Neisseria meningitidis 17 (x/y; 25.1%) and E. coli with 3 (4.5%). Two different fungi, Cryptococcus neoformans and Candida albicans represented 3 (4.4%) of causative agents. The most common treatment was Ceftriaxone which was the most active/sensitive to all bacterial agents.Conclusion: Children under 5 years of age are the most affected, and the higher prevalence occurs during the dry season in the eastern region. Streptococcus pneumoniae was the leading cause of meningitis, and ceftriaxone antibiotic was the most active to the majority of identified bacteria.

Analysis of current epidemiological and clinical characteristics for laboratory confirmed epidemic cerebrospinal meningitis cases in Shandong Province, 2007-2016

Objective: To analyze epidemiological and clinical characteristics of laboratory confirmed epidemic cerebrospinal meningitis cases. Methods: Epidemiological and clinical informations and cerebrospinal fluid (CSF) and blood specimens of AMES (acute meningitis/encephalitis syndrome) cases were collected in the six sentinel hospitals from 2007 to 2016. neisseria meningitides (Nm) species and serogroup identification were detected by the methods of real-time fluorescent quantitative polymerase chain reaction (Real-time PCR) and bacterial culture, and epidemiological and clinical characteristics of laboratory confirmed epidemic cerebrospinal meningitis cases were analyzed. Results: 6 809 AMES cases were reported from 2007 to 2016. Total 4 422 cases were detected, and 90 cases were Nm positive. Through the methods of Real-time PCR, bacterial blood culture and CSF culture, the numbers of Nm positive cases were 90, 2 and 1 respectively. Twenty-two Nm cases were identified from 2007 to 2011 (4 cases were ungrouped), which with the highest incidence in serogroup C cases (17/18), and one cases was ungroupable Nm. Nm laboratory confirmed cases (68 cases) were increased dramatically and mainly occurred in serogroup B cases (43/67, 64.2%) from 2012 to 2016, with serogroup C cases highly decreased (5/67, 7.5%) and ungroupable Nm cases increased (13/67, 19.4%) meanwhile. Serogroup W135 and X cases were first detected at 2012 and 2014, and serogroup A remaining a low level which only detected one case at 2013. The morbidity of epidemic cerebrospinal meningitis was occured in the whole year, and mainly in winter and spring. The ratio of Nm laboratory confirmed cases to AMES cases during November to May (3.5%, 67/1 920) was higher than that during June to October (0.9%, 23/2 502) (χ(2)=34.45, P<0.001). Most Nm cases were children, students and farmers, and account for 30.0% (27/90), 31.1% (28/90), 18.9% (17/90), respectively. The majority of Nm cases were under 20 years old (60/90, 66.67%), and serogroup C cases (17/22, 77.3%) mainly occurred in over 12 years old population, while serogroup B (24/43, 55.8%) and ungroupable (6/14) cases mainly occurred in under 12 years old population. The main clinical symptoms of epidemic cerebrospinal meningitis cases were fever (78/90, 86.7%), headache (59/90, 65.6%) and vomiting (51/90, 56.7%). Misdiagnosis rate of admitting diagnosis was up to 87.8% (79/90) for the reason of atypical features in specific symptoms and blood or CSF positive index. The well-healed ratio in correct diagnosed group (7/11) was higher than that in misdiagnosed group (2.5%, 2/79) (χ(2)=40.61, P<0.001). Conclusion: The clinical symptoms of epidemic cerebrospinal meningitis cases were atypical, and the diagnosed sensitivity and accuracy would be improved by enhanced molecular biology detection. The predominant epidemic serogroup of Nm switched from serogroup C to B, and the key work was surveaylance of serogroup transition.

Meningitis and encephalitis in Poland in 2016

Meningitis and encephalitis are febrile diseases with varying degrees of severity, rich symptomatology and differentiated course depending on the etiological factor and individual sensitivity. In severe cases, it can quickly lead to shock and death. mAbout 3000 cases of meningitis and encephalitis are registered in Poland each year. They constitute a serious diagnostic and therapeutic problem. Among the cases of cerebrospinal meningitis and / or encephalitis, confirmed by laboratory tests, the most common are Neisseria meningitidis and Streptococcus pneumoniae. Among viral neuroinfections, tick-borne encephalitis predominates. The aim of the study is to assess the epidemiological situation of meningitis and / or encephalomyelitis in Poland in 2016. and comparison of the results obtained with the epidemiological situation in previous years. Analysis and assessment of the epidemiological situation of the occurrence of meningitis and / or encephalomyelitis in Poland in 2016. was based on the results of the analysis of aggregate data published in the annual bulletins: “Infectious diseases and poisoning in Poland in 2016” and “Protective Vaccination in Poland in 2016. (Czarkowski MP. Et al., Warsaw, NIZP-PZH, GIS). In addition, the recommendations from the Protective Vaccine Program for 2016 were used. In 2016, in Poland, there were a total of 3,191 cases of meningitis and / or encephalitis (incidence 7.6 per 100,000), which increased by 14.5% compared to 2015. The prevalences of viral etiology were they were responsible for 43.49% of cases of neuroinfections. Among the specific neuroinfections with viral etiology, up to 74.67% were tick-borne encephalitis (TBE). Disorders of bacterial etiology were the cause of 30.08% of all cases, which is an increase of 6.35% compared to 2015. In 2016, the total increase in meningitis and / or brain inflammation was recorded in Poland. In comparison to 2015, it was an increase of 14.5%. Most of these infections were infections caused by viruses - 43.49%. 2016 was another period in which a decline in bacterial etiology was noted, which may result from the fact that more protective vaccinations were carried out in this area. It is necessary to continue educational activities aimed at raising the level of knowledge of the general public in the area of the ability to prevent infectious diseases through vaccination.

Cerebrospinal meningitis in Kebbi State, Nigeria: 2015 - 2016

Introduction : cerebrospinal meningitis (CSM) is an epidemic-prone vaccine preventable disease associated with high mortality and morbidity, especially in developing countries like Nigeria. It is regarded as a priority disease in the Integrated Disease Surveillance and Response (IDSR) system in Nigeria. We analyzed surveillance data to describe the epidemiology of CSM in Kebbi State, 2015 - 2016. Methods : we reviewed surveillance data abstracted from Kebbi State IDSR data-base for the years 2015 - 2016. A suspected case of CSM was defined as: any person with sudden onset of fever (>38.5oc rectal or 38oc axillary) and one of the following signs: neck stiffness, altered consciousness or other meningeal signs. A confirmed case was defined as a suspected case confirmed by isolation of Neisseria meningitidis from Cerebro-spinal fluid (CSF) or blood. We computed frequencies and proportions. Results : a total of 2088 suspected cases of CSM were reported during the period under review with a cumulative attack rate of 48.6/100,000 and 2.3/100,000 in 2015 and 2016 respectively. Mean age was 12.9 ± 9.5 years. Males constituted 1183 (56.7%) of the reported cases. Persons aged 10-15 years accounted for the highest number of cases 720 (34.5%). All patients were treated with Intra-muscular or Intra-venous Ceftriaxone according to the national treatment guidelines. Only 140 (6.7%) patients, had their CSF samples taken of which 76 (54.3%) were positive for Neisseria meningitides serotype C. Ninety three of the total patients died during the reporting period (case fatality rate 4.5%). Amongst those that died, only 2 (2.2%) were laboratory confirmed. One thousand two hundred and fifty four (60.1%) of the cases had a single dose of Meningococcal polysaccharide vaccine, 803 (38.5%) were unvaccinated. Conclusion : the laboratory component of the surveillance system and the vaccination coverage were poor. We recommended further improvement in laboratory surveillance and vaccination activities in the State.

Outbreak investigation of Neisseria meningitides serogroup C Meningitis in Kano State, March - May 2017

Introduction: Nigeria experienced a multi-state outbreak of Cerebrospinal Meningitis (CSM) from Neisseria meningitides serogroup C (Nmc) in March 2017. Kano State, one of the affected 22 states reported its first two confirmed CSM cases on March 22nd 2017. NFELTP residents were deployed to the state to determine the magnitude of the outbreak and characterize it in time, place, and person, and to carry out response activities to control the outbreak.

OUTBREAK OF CEREBROSPINAL MENINGITIS IN KEBBI STATE, NIGERIA.

Cerebrospinal meningitis (CSM), is a major public health problem still affecting tropical countries particularly in sub-Saharan Africa. Group A and occasionally group C account for large scale epidemics in many countries in the African meningitis belt. The study aimed to describe the pattern of cerebrospinal meningitis outbreak in Kebbi state in 2015. Information on cases and deaths was collected throughout the duration of the meningitis outbreak in all affected local government areas of Kebbi state. During this outbreak, we defined a suspected case as any person with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, altered consciousness or other meningeal signs and any toddler with sudden onset of fever (>38.5 C rectal or 38.0 C axillary) and one of the following signs: neck stiffness, or flaccid neck, bulging fontanel, convulsion or other meningeal signs. All the data was entered into SPSS statistical software and analyzed. A total of 1,992 suspected cases of CSM were seen within the 18 weeks that the outbreak lasted. 1127 (57.0%) were males and 865 (43.0%) were females with a case fatality rate of 4.0%. The highest proportion of cases was found among those above 15 years of age (31.0%), 1252 (62.9%) of cases were immunized against neisseria meningitides type A. Two-thirds (16) of the LGAs in the state were affected and Aliero LGA had about half (n=1106; 55.5%) of cases seen. Most (77.3%) of samples analysed were positive for Nm type C. Kebbi state experienced an outbreak of cerebro-spinal Meningitis in 2015 which was massive. Effective surveillance system and mass vaccination with polyvalent vaccines containing serogroup C will prevent future occurrence.

Invasive Meningococcal Meningitis Serogroup C Outbreak in Northwest Nigeria, 2015 - Third Consecutive Outbreak of a New Strain.

BACKGROUND: In northwest Nigeria in 2013 and 2014, two sequential, localized outbreaks of meningitis were caused by a new strain of Neisseria meningitidis serogroup C (NmC). In 2015, an outbreak caused by the same novel NmC strain occurred over a wider geographical area, displaying different characteristics to the previous outbreaks. We describe cases treated by Médecins Sans Frontières (MSF) in the 2015 outbreak. METHODS: From February 10 to June 8, 2015, data on cerebrospinal meningitis (CSM) cases and deaths were recorded on standardized line-lists from case management sites supported by MSF. Cerebrospinal fluid (CSF) samples from suspected cases at the beginning of the outbreak and throughout from suspected cases from new geographical areas were tested using rapid Pastorex® latex agglutination to determine causative serogroup. A subset of CSF samples was also inoculated into Trans-Isolate medium for testing by the WHO Collaborating Centre for Reference and Research on Meningococci, Oslo. Reactive vaccination campaigns with meningococcal ACWY polysaccharide vaccine targeted affected administrative wards. RESULTS: A total of 6394 (65 confirmed and 6329 probable) cases of CSM including 321 deaths (case fatality rate: 5.0%) were recorded. The cumulative attack rate was 282 cases per 100,000 population in the wards affected. The outbreak lasted 17 weeks, affecting 1039 villages in 21 local government areas in three states (Kebbi, Sokoto, Niger). Pastorex® tests were NmC positive for 65 (58%) of 113 CSF samples. Of 31 Trans-Isolate medium samples, 26 (84%) tested positive for NmC (14 through culture and 12 through PCR); all had the same rare PorA type P1.21-15,16 as isolates from the 2013 and 2014 outbreaks. All 14 culture-positive samples yielded isolates of the same genotype (ST-10217 PorA type P1.21-15,16 and FetA type F1-7). More than 222,000 targeted individuals were vaccinated relatively early in the outbreak (administrative coverage estimates 98% and 89% in Kebbi and Sokoto, respectively). CONCLUSIONS: The outbreak was the largest caused by NmC documented in Nigeria. Reactive vaccination in both states may have helped curtail the epidemic. A vaccination campaign against NmC with a long-lasting conjugate vaccine should be considered in the region.

Climatic Variables and Disease Incidence in Ghana: A Study of Cerebrum Spinal Meningitis (CSM)

Aim: The study was undertaken to evaluate the effects of climatic factors on the outbreak of Cereb rospinal Meningitis (CSM) in the Obuasi Municipality of Ghana. Significance: The project provides a validated climatic pattern and serves as reference point to: 1. Health administrators on CSM emergency preparedness which could lead to the prevention of fa talities as measures would be put in place to address an occurrence. 2. Environmentalists on the environmental factors that cause CSM outbreak. 3. Health consultants for sensitization and creations of awareness of the causes of CSM. 4. Stakeholders for pla nning and implementation of outbreak preparedness methods and strategy. Methodology: Time series data on rainfall, temperature, and relative humidity was obtained from Ghana Meteorological Agency in Accra and AngloGold Ashanti, Obuasi. The rainfall and tem perature values were taken from 1980 to 20 11 while that of relative humidity was drawn from 1987 to 20 11 due to the unavailability of data. Data on the reported case of CSM was obtained

Investigation Of An Epidemic Of Meningitis In Baruten Local Government Area Of Kwara State, Nigeria

This is a report of an investigation into an outbreak of meningitis in three communities of Baruten Local Government Area (LGA) of Kwara State, Nigeria. A total of 41 cases of cerebrospinal meningitis (CSM) were reported. There was a preponderance of males (78%). Thirty-eight (92.7%) did not receive CSF vaccine while the remaining 3 (7.3%) that receive the vaccine were vaccinated less than a week before the onset of illness. Case Fatality Rate (CFR) was 7.3%. About half (46.3%) of the cases were aged between 6-15 years. The outbreak could have been prevented if adequate supplies of CSM vaccine were provided and vaccination conducted early enough. Government policy of mass immunization against meningitis in November of every year should be implemented and properly monitored to prevent future outbreaks of meningitis and its resultant morbidity and mortality. Key Words: Cerebrospinal meningitis, Outbreak, Kwara State, Nigeria. Afr. J. Clin. Exper. Microbiol. 2004; 5 (3): 247-251

Cutaneous Medicine

Infections Virus Extensive herpetic eruptions of the lips may be serious, owing to subsequent scarring causing circumoral constriction. Herpes labialis occurs in 25 to 50 per cent of cases of cerebrospinal meningitis on the fourth or fifth day of the disease. It is probably due to the ever-present virus, being activated by febrile illness.Toward the close of the nineteenth century a complication of infantile eczema characterized by a so-called "varicelliform eruption" was first described by Kaposi156 as an acute outbreak of numerous vesicles, partly scattered and partly arranged in groups. The vesicles are as large as lentils and are . . .

MENINGOCOCCIC CONJUNCTIVITIS

Although meningococcic conjunctivitis has long been recognized as a complication of cerebrospinal meningitis, its incidence has diminished notably in recent years with the introduction of antimeningococcic serum therapy. Thus, Randolph,¹in 1893, cited Hirsch, Ziemssen and Hess as finding it an invariable concomitant of the cerebral disease. But, with the advent of serum therapy, no conjunctivitis occurred in a series of 66 cases reported by Lewis²in 1931 and was present in only 1 of a large number of cases reported by Tillet and Brown³in 1935. Cushing,⁴in 1940, was able to demonstrate only 4 instances of conjunctivitis among 124 cases of cerebrospinal meningitis. Acute meningococcic conjunctivitis without any other clinical evidence of meningitis, or its development prior to the onset of meningitis, however, is not common at all, there being only infrequent reports of such an occurrence in the literature. Koplik,⁵in 1904,

Bacteriological Researches on Cases of Cerebrospinal Meningitis, Convalescents and Carriers

Bacteriological Researches on Cases of Cerebrospinal Meningitis, Convalescents and Carriers

Six Cases of Cerebrospinal Meningitis Treated with M & B 693, Military Isolation Hospital, Aldershot

Six Cases of Cerebrospinal Meningitis Treated with M & B 693, Military Isolation Hospital, Aldershot

A Case of Cerebrospinal Meningitis: Illustrating Certain of the Principles of Treatment of the Disease

A Case of Cerebrospinal Meningitis: Illustrating Certain of the Principles of Treatment of the Disease

High and Persistent Carrier Rates ofNeisseria meningitidis, unaccompanied by Cases of Meningitis

1. In Chatham naval hospital a carrier rate for agglutinable meningococci of 50 per cent, persisted for over a year, during which period there were no cases of cerebro-spinal meningitis among the naval and military population of the port.2. During the same period the carrier rate at Portsmouth among the contacts to six cases of meningitis was 5 per cent.3. During the year previous to the present Chatham investigation the carrier rate at Chatham was 13 per cent, among the contacts to five cases of C.S.M.4. There was no association of the meningococcus carrier rate with density of population or season of the year.5. The most senior ratings, with the most spacious accommodation, had as high a carrier rate (60 per cent.) as the recruits with the worst sleeping quarters. Ratings of intermediate seniority had an intermediate rate (38 per cent.).6. Agglutination tests indicated that the antigenic composition of the bacterial herd ofN. meningitidischanged rather suddenly, while the total meningococcal carrier rate remained constant.7. Many of the above recent observations are at variance to what was seen at Chatham, and elsewhere, during the Great War. An attempt is made therefore to reconcile the past with the present experiences.Our thanks are due to Surgeon-Commander J. A. O'Flynn, who kindly tested our culture medium and supplied the Portsmouth C.S.M. data, and also to Chief Petty Officer R. Kircher, R.N., Sick Berth Staff, who did all the nasopharyngeal swabbing (in order to keep the personal equation constant), as well as much of the technical laboratory work.

Treatment of Cerebrospinal Meningitis Cases, as carried out at R.N. Hospital, Chatham

Treatment of Cerebrospinal Meningitis Cases, as carried out at R.N. Hospital, Chatham