Bacterial meningitis in children in Libreville, Gabon. Epidemiologic, therapeutic and prognostic features.

Bacterial meningitis is a very serious pediatric problem in tropical areas. Objective - This study was carried out in the Pediatric Unit of Owendo Pedi atric Hospital in Libreville, to collect reliable data on bacterial meningi tis in Gabon, in terms of frequency, bacteriologic distribution, severity a nd prognosis. Method - The authors reviewed the files of ail the patients admitted for ba cterial meningitis from January 1, 1989 to December 31, 1993. Results - One hundred and four cases (48 boys, 56 girls) of bacterial menin gitis were reported out of 8,654 patients admitted during the study period, i.e., 1.2% of admissions. Sixty-one patients (58.6%) were under one year o f age and 87 (83.6%) under five years of age. The most common bacterial age nts were Streptococcus pneumoniae (40.4%), Haemophilus influenzae (34.6%), and Salmonella sp. (8.7%). Delayed diagnosis (> five days) was observed for 61.6% of patients. Ampicillin and chloramphenicol resistance was observed: Streptococcus pneumoniae 29.6% and 25.9%, respectively; Haemophilus influe nzae 42.8% and 28.8%; and Salmonella sp. 77.8% and 66.6%. The overall death rate reached 28.1%, with rates of 31.4% and 55.5% for cases involving H. i nfluenzae and Salmonella sp., respectively. Most deaths occurred in the you nger age group (79.3%) and within 48 hours of admission (62%). The sequela rate was 16.2%. Conclusion - Prompt diagnosis, adequate treatment and especially preventive measures are needed to improve the prognosis for bacterial meningitis. (C) 2000 Editions scientifiques et medicales Elsevier SAS.