Acute bacterial meningitis in the Gambia: A four-year review of paediatrichospital admissions

Over a 4 year period, 1991 to 1994, 420 patients with acute bacterial menin gitis were admitted to a tertiary urban hospital in The Gambia, Organisms w ere isolated from the cerebrospinal fluid in 64 per cent of cases, In the n eonatal period Streptococcus pneumoniae was the single most common organism isolated. Amongst infants and children tbe two major pathogens were Haemop hilus influenzae and S, pneumoniae, In the first year of life, children wit h S, pneumoniae meningitis were younger than those with H. influenzae infec tion (median age 3 months versus 6 months,p < 0.00003) and they had a highe r case fatality rate (37 per cent versus 17 per cent,p = 0.002), In view of the high case fatality rate, there is a need to review overall case manage ment. This will include a review of more effective antibiotics, the possibl e role of dexamethasone, and the inclusion of efficacious vaccines against H. influenzae and S, pneumoniae disease.