1. Etiology of Pediatric Meningitis in West Africa Using Molecular Methods in the Era of Conjugate Vaccines against Pneumococcus, Meningococcus, and Haemophilus influenzae Type b
- Author
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Nuredin Mohammed, Mamadou Kourna Hama, Jie Liu, Adam L. Cohen, Fatima Serhan, Archibald Worwui, Eric R. Houpt, Peter Sylvanus Ndow, Jason M. Mwenda, Catherine Okoi, Brenda Kwambana-Adams, Mouhamadou A. Sonko, Enyonam Tsolenyanu, Richard Mihigo, Jean Gratz, Muhammad Faruk Bashir, Martin Antonio, Lorna Renner, Beckie N. Tagbo, and Daniel Ansong
- Subjects
030231 tropical medicine ,Neisseria meningitidis ,medicine.disease_cause ,law.invention ,Microbiology ,03 medical and health sciences ,0302 clinical medicine ,law ,Virology ,Streptococcus pneumoniae ,medicine ,TaqMan ,Humans ,Meningitis ,Child ,Pathogen ,Polymerase chain reaction ,Vaccines, Conjugate ,biology ,business.industry ,Haemophilus influenzae type b ,Articles ,medicine.disease ,biology.organism_classification ,Diarrhea ,Africa, Western ,Infectious Diseases ,Etiology ,Parasitology ,medicine.symptom ,business ,Bacteria - Abstract
Despite the implementation of effective conjugate vaccines against the three main bacterial pathogens that cause meningitis, Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis serogroup A, the burden of meningitis in West Africa remains high. The relative importance of other bacterial, viral, and parasitic pathogens in central nervous system infections is poorly characterized. Cerebrospinal fluid (CSF) specimens were collected from children younger than 5 years with suspected meningitis, presenting at pediatric teaching hospitals across West Africa in five countries including Senegal, Ghana, Togo, Nigeria, and Niger. Cerebrospinal fluid specimens were initially tested using bacteriologic culture and a triplex real-time polymerase chain reaction (PCR) assay for N. meningitidis, S. pneumoniae, and H. influenzae used in routine meningitis surveillance. A custom TaqMan Array Card (TAC) assay was later used to detect 35 pathogens including 15 bacteria, 17 viruses, one fungus, and two protozoans. Among 711 CSF specimens tested, the pathogen positivity rates were 2% and 20% by the triplex real-time PCR (three pathogens) and TAC (35 pathogens), respectively. TAC detected 10 bacterial pathogens, eight viral pathogens, and Plasmodium. Overall, Escherichia coli was the most prevalent (4.8%), followed by S. pneumoniae (3.5%) and Plasmodium (3.5%). Multiple pathogens were detected in 4.4% of the specimens. Children with human immunodeficiency virus (HIV) and Plasmodium detected in CSF had high mortality. Among 220 neonates, 17% had at least one pathogen detected, dominated by gram-negative bacteria. The meningitis TAC enhanced the detection of pathogens in children with meningitis and may be useful for case-based meningitis surveillance.
- Published
- 2020