Serotypes of Bacteria Encountered in Childhood Purulent Meningitis in Children in Parakou (Benin) in 2011

Introduction: In the North-Benin, there are three agents causing pediatric purulent meningitis outside the neonatal period. These are: Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b. The aim of this research work was to investigate bacteria serotypes that caused childhood purulent meningitis in the pediatric unit of the Borgou à Regional University Teaching Hospital (CHUD-Borgou) located in Parakou (North-Benin). Patients and Methods: Through a prospective and descriptive study centered on children aged 0 to 5 years old suspected of meningitis and hospitalized, the cerebrospinal fluid (CSF) samples of those children were analyzed at the WHO reference laboratory in Banjul for serotyping by real time polymerase chain reaction (RT/PCR). Results: Among the 1396 children hospitalized during that period, 366 were suspected of meningitis and had benefitted from lumbar puncture. Among those 366 suspected cases, 51 cases of purulent meningitis were confirmed after CSF cytobacteriological and biochemical test at the CHUD-Borgou laboratory. Among 51 CSF samples in which purulent meningitis was confirmed, 44 were sent to Banjul. In addition, 310 CSF samples from non-confirmed cases of meningitis were also sent to Banjul. In the whole set of samples sent for real time PCR, 151 cases of Streptococcus pneumoniae (42.7%) were found, 5 cases of Neisseria meningitidis (1.4%) and 1 case of Haemophilus influenzae (0.3%) were also encountered. As regards Streptococcus pneumonia, the serotypes encountered were: 1, 3, 4, 5, 7F, 8, 9V, 9V/9A, 9N/9L, 14, 18C, 19A, 23F, 33F as well as non typed and non typable serotypes. As for Neisseria meningitidis, only serogroup A was found in it. For Haemophilus influenzae, only serotype b was identified. Conclusion: Four non vaccine serotypes (8, 9V/9A, 9N/9L and 33F), non typed and non typable serotypes which are not covered by 13-valent pneumococcal conjugate vaccine (PCV 13) were identified. This highlights the need to enhance surveillance of pediatric purulent meningitis and serotyping by RT/PCR of all CSF samples in order to adapt if necessary future new pneumococcal vaccines to circulating non vaccine serotypes.

Limb Malformation Secondary to Maternal Diabetes: A Case at Mother and Children Tertiary Hospital in Cotonou-Benin Republic

Diabetes in pregnant women could be source of morbidity and mortality if management was not optimal. One of the main complications of diabetes in pregnant women is birth defects. They have an estimated prevalence of 1.5%. They can be isolated or associated to other malformations. Prevention includes systematic screening when monitoring pregnancies, in particular carrying out morphological obstetrical ultrasounds. A case of limb malformation secondary to unbalanced maternal diabetes and absence of prenatal diagnosis despite the high number of ultrasounds that have been performed is reported here. This situation requests more attention to the quality of antenatal ultrasounds caregiving in developing countries.

Pediatric Hypertension in Two University Hospitals in Cotonou, Benin: Presentation, Etiology, Management and Outcome

Background: Hypertension (HPT) is a major public health problem. Many studies have attempted to investigate HPT in school children. Few, however, have targeted hospital HPT. We conducted this study to describe the epidemiologic characteristics, etiologies, management, and outcome of hospital HPT in our setting. Methods: This was a prospective and descriptive study carried out from March 01 through June 30, 2017 in the pediatric departments of two university hospitals: Centre National Hospitalier Universitaire Hubert K. Maga and Centre Hospitalier Universitaire de la Mère et de L’Enfant Lagune of Cotonou, Benin. Every consecutive patient aged 3 to 18 years who was admitted to the two hospitals for any reason had his (her) BP measured. Every patient with HPT was reviewed for demographics, history and clinical examination, and laboratory investigations as appropriate. Management was done accordingly. Outcome was also recorded. Results: The hospital frequency of HPT was 1.98% (31 cases/1565 admissions). The male/female ratio was 1.06 (16 males, 15 females). Mean age was 8.5 years ± 4.39 (range, 3 to 16 years). 74.19% patients had Body mass index within -2SD and +2SD. Only one patient had BMI above +3SD. The main etiologies found were renal: acute tubular necrosis (45.16%), acute glomerulonephritis (16.13%), and acute pyelonephritis (12.90%). Diuretics (64.5%), were the main antihypertensive drugs used. A single drug therapy was used in 35.4%, a two-drug therapy in 32.2% and a three-drug therapy in 9.6% of cases. Length of hospital stay was more than one week in 70.97% of cases. Hospital death rate for HPT was 19.35%. The outcome was not known in one patient due to exit from hospital against medical advice. All the other patients fully recovered at one month post-discharge follow-up. Conclusion: HPT presents as a symptomatic disease in our hospitals;it has a renal etiology in most cases and has significant death rate despite treatment. Advocacy with health authorities must be the way out of issues of HPT management in our setting.

Elevated plasma interleukin-8 as a risk factor for mortality in children presenting with cerebral malaria

Background Cerebral malaria(CM)is a neuropathology which remains one of the deadliest forms of malaria among African children.The kinetics of the pathophysiological mechanisms leading to neuroinflammation and the death or survival of patients during CM are still poorly understood.The increasing production of cytokines,chemokines and other actors of the inflammatory and oxidative response by various local actors in response to neuroinflammation plays a major role during CM,participating in both the amplification of the neuroinflammation phenomenon and its resolution.In this study,we aimed to identify risk factors for CM death among specific variables of inflammatory and oxidative responses to improve our understanding of CM pathogenesis.Methods Children presenting with CM(n=70)due to P.falciparum infection were included in southern Benin and divided according to the clinical outcome into 50 children who survived and 20 who died.Clinical examination was complemented by fundoscopic examination and extensive blood biochemical analysis associated with molecular diagnosis by multiplex PCR targeting 14 pathogens in the patients'cerebrospinal fluid to rule out coinfections.Luminex technology and enzyme immunoassay kits were used to measure 17 plasma and 7 urinary biomarker levels,respectively.Data were analysed by univariate analysis using the nonparametric Mann-Whitney U test and Pearson’s Chi2 test.Adjusted and multivariate analyses were conducted separately for plasma and urinary biomarkers to identify CM mortality risk factors.Results Univariate analysis revealed higher plasma levels of tumour necrosis factor(TNF),interleukin-1beta(IL-1β),IL-10,IL-8,C-X-C motif chemokine ligand 9(CXCL9),granzyme B,and angiopoietin-2 and lower urinary levels of prostanglandine E2 metabolite(PGEM)in children who died compared to those who survived CM(Mann-Whitney U-test,P-values between 0.03 and<0.0001).The multivariate logistic analysis highlighted elevated plasma levels of IL-8 as the main risk factor for death during CM(adjusted odd ratio=14.2,P-value=0.002).Values obtained during follow-up at D3 and D30 revealed immune factors associated with disease resolution,including plasma CXCL5,C-C motif chemokine ligand 17(CCL17),CCL22,and urinary 15-F2t-isoprostane.Conclusions The main risk factor of death during CM was thus elevated plasma levels of IL-8 at inclusion.Follow-up of patients until D30 revealed marker profiles of disease aggravation and resolution for markers implicated in neutrophil activation,endothelium activation and damage,inflammatory and oxidative response.These results provide important insight into our understanding of CM pathogenesis and clinical outcome and may have important therapeutic implications.

Non-traumatic coma in young children in Benin:are viral and bacterial infections gaining ground on cerebral malaria?

Background:While malaria morbidity and mortality have declined since 2000,viral central nervous system infections appear to be an important,underestimated cause of coma in malaria-endemic Eastern Africa.We aimed to describe the etiology of non-traumatic comas in young children in Benin,as well as their management and early outcomes,and to identify factors associated with death.Methods:From March to November 2018,we enrolled all HIV-negative children aged between 2 and 6 years,with a Blantyre Coma Score≤2,in this prospective observational study.Children were screened for malaria severity signs and assessed using a systematic diagnostic protocol,including blood cultures,malaria diagnostics,and cerebrospinal fluid analysis using multiplex PCR.To determine factors associated with death,univariate and multivariate analyses were performed.Results:From 3244 admissions,84 children were included:malaria was diagnosed in 78,eight of whom had a viral or bacterial co-infection.Six children had a non-malarial infection or no identified cause.The mortality rate was 29.8%(25/84),with 20 children dying in the first 24 h.Co-infected children appeared to have a poorer prognosis.Of the 76 children who consulted a healthcare professional before admission,only 5 were prescribed adequate antimalarial oral therapy.Predictors of early death were jaundice or increased bilirubin[odd ratio(OR)=8.6;95% confidential interval(CI):2.03-36.1]and lactate>5 mmol/L(OR=5.1;95%CI:1.49-17.30).Antibiotic use before admission(OR=0.1;95%CI:0.02-0.85)and vaccination against yellow fever(OR=0.2,95%CI:0.05-0.79)protected against mortality.Conclusions:Infections were found in all children who died,and cerebral malaria was by far the most common cause of non-traumatic coma.Missed opportunities to receive early effective antimalarial treatment were common.Other central nervous system infections must be considered in their management.Some factors that proved to be protective against early death were unexpected.