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1 January 2005

Volume 40, Number 1
Clinical Infectious Diseases 2005;40:17–25
1058-4838/2005/4001-0004$15.00
DOI: 10.1086/426436
MAJOR ARTICLE

Bacterial Meningitis in Burkina Faso: Surveillance Using Field‐Based Polymerase Chain Reaction Testing

Isabelle Parent du Châtelet,1

Yves Traore,4,a

Bradford D. Gessner,1

Aude Antignac,2

B. Naccro,5,a

Berthe‐Marie Njanpop‐Lafourcade,1

Macaire S. Ouedraogo,1

Sylvestre R. Tiendrebeogo,6

Emmanuelle Varon,3 and

Muhammed K. Taha2

1Association pour l’Aide à la Médecine Préventive, 2Unité des Neisseria, Institut Pasteur, and 3Centre National de Référence des Pneumocoques, Hôpital Européen G. Pompidou, Paris, France; and 4Centre Muraz and 5Centre Hospitalier National Souro Sanou, Bobo‐Dioulasso, and 6Direction de la Lutte Contre la Maladie, Ministère de la Santé, Ougadougou, Burkina Faso

Background.In addition to frequent epidemics of group A meningococcal disease, endemic bacterial meningitis due mostly to Neisseria meningitidis, pneumococcus, and Haemophilus influenzae type b is a serious problem in sub‐Saharan Africa. The improved ability to identify the etiologic agent in cases of bacterial meningitis will facilitate more rapid administration of precise therapy.

Methods.To describe the epidemiology of bacterial meningitis and evaluate the usefulness of field‐based polymerase chain reaction (PCR) testing, we implemented population‐based meningitis surveillance in Burkina Faso during 2002–2003 by use of PCR, culture, and antigen detection tests.

Results.Among persons aged 1 month to 67 years, the incidences of meningococcal meningitis, pneumococcal meningitis, and Haemophilus influenzae type b meningitis were 19 cases ( ), 17 cases ( ), and 7.1 cases ( ) per 100,000 persons per year, respectively. Of the cases of meningococcal meningitis, 72% were due to N. meningitidis serogroup W135. Pneumococcal meningitis caused 61% of deaths and occurred in a seasonal pattern that was similar to that of meningococcal meningitis. Of cases of pneumococcal meningitis and N. meningitidis serogroup W135 meningitis, 71% occurred among persons >2 years of age. Most patients, regardless of the etiology of their illness and the existence of an epidemic, received short‐course therapy with oily chloramphenicol. Compared with culture as the gold standard, the sensitivity and specificity of PCR in the field were high; this result was confirmed in Burkina Faso and Paris.

Conclusions.Precise and rapid identification of etiologic agents is critical for improvement in the treatment and prevention of meningitis, and, thus, PCR should be considered for wider use in Africa. Vaccines against Streptococcus pneumoniae, N. meningitidis (including serogroup W135), and H. influenzae type b all will have a major impact on the bacterial meningitis burden. Antibiotic recommendations need to consider the importance of S. pneumoniae, even during the epidemic season.

Received 14 April 2004; accepted 10 August 2004; electronically published 8 December 2004.

Reprints: Dr. Bradford D. Gessner, Association pour l’Aide à la Médecine Préventive, Institut Pasteur, 28 rue du Docteur Roux, 75015, Paris, France. Correspondence: Dr. Bradford D. Gessner, 11100 Stony Brook Dr., Anchorage, AK 99516 ().

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  • Y.T. for the Laboratory Group and B.N. for the Clinical Investigators Group. Members of the study groups are listed at the end of the text.

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