Dynamics of germs responsible for acute bacterial meningitis in Burkina Faso in the last ten years (2005-2014)

The aim of this study was to analyze ten (10) years of epidemiological surveillance data of meningitis in Burkina Faso for high risk germs patterns identification in order to contribute to the strengthening of prevention strategies.A retrospective study of the past decade (2005- 2014) of cases of acute bacterial meningitis occurred in the thirteen health regions, collected through epidemiological surveillance data meningitis in Burkina Faso. From a total of 88 057 suspected cases of acute bacterial meningitis, we recorded 9134 deaths. From the laboratory confirmed cases, the identified germs were as follows: 56.79% of Neisseria meningitidis, 41.09% of Streptococcus pneumoniae and 2.13% of Haemophilus influenzae. Among the meningococcus isolated, we observed the following distribution: 23.11% of NmA, 58.84% of NmW and 18% of NmX.Mortality associated with acute bacterial meningitis remains still high in Burkina Faso despite the complete disappearance of NmA since 2012, after the conjugate vaccine A (MenAfriVac) has been introduced in this country. However the emergence of NmX, the reemergence of NmW and the persistence of high prevalence of Streptococcus pneumoniae are a major concern in the fight against meningitis in Burkina Faso. So, it is necessary, in addition to the strengthening of surveillance, diagnosis and case management to develop and make available and accessible a conjugate trivalent vaccine against NmA the NmX and NmW serogroups.Keywords: meningococcal meningitis, W and X serogroups, Streptococcus pneumoniae, MenAfriVa

Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study

Background Pneumonia is the leading cause of death among children younger than 5 years. In this study, we estimated causes of pneumonia in young African and Asian children, using novel analytical methods applied to clinical and microbiological findings. Methods We did a multi-site, international case-control study in nine study sites in seven countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. All sites enrolled in the study for 24 months. Cases were children aged 1–59 months admitted to hospital with severe pneumonia. Controls were age-group-matched children randomly selected from communities surrounding study sites. Nasopharyngeal and oropharyngeal (NP-OP), urine, blood, induced sputum, lung aspirate, pleural fluid, and gastric aspirates were tested with cultures, multiplex PCR, or both. Primary analyses were restricted to cases without HIV infection and with abnormal chest x-rays and to controls without HIV infection. We applied a Bayesian, partial latent class analysis to estimate probabilities of aetiological agents at the individual and population level, incorporating case and control data. Findings Between Aug 15, 2011, and Jan 30, 2014, we enrolled 4232 cases and 5119 community controls. The primary analysis group was comprised of 1769 (41·8% of 4232) cases without HIV infection and with positive chest x-rays and 5102 (99·7% of 5119) community controls without HIV infection. Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6–97·3%). 30-day case-fatality ratio was 6·4% (114 of 1769 cases). Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status. The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3–65·6) of causes, whereas bacteria accounted for 27·3% (23·3–31·6) and Mycobacterium tuberculosis for 5·9% (3·9–8·3). Viruses were less common (54·5%, 95% CrI 47·4–61·5 vs 68·0%, 62·7–72·7) and bacteria more common (33·7%, 27·2–40·8 vs 22·8%, 18·3–27·6) in very severe pneumonia cases than in severe cases. RSV had the greatest aetiological fraction (31·1%, 95% CrI 28·4–34·2) of all pathogens. Human rhinovirus, human metapneumovirus A or B, human parainfluenza virus, S pneumoniae, M tuberculosis, and H influenzae each accounted for 5% or more of the aetiological distribution. We observed differences in aetiological fraction by age for Bordetella pertussis, parainfluenza types 1 and 3, parechovirus–enterovirus, P jirovecii, RSV, rhinovirus, Staphylococcus aureus, and S pneumoniae, and differences by severity for RSV, S aureus, S pneumoniae, and parainfluenza type 3. The leading ten pathogens of each site accounted for 79% or more of the site's aetiological fraction. Interpretation In our study, a small set of pathogens accounted for most cases of pneumonia requiring hospital admission. Preventing and treating a subset of pathogens could substantially affect childhood pneumonia outcomes

Association of C-reactive protein with bacterial and respiratory syncytial virus-associated pneumonia among children aged <5 years in the PERCH study

Background. Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study. Methods. We measured serum CRP levels in cases with World Health Organization-defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for "confirmed" bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to "RSV pneumonia" (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases. Results. Among 601 human immunodeficiency virus (HIV)-negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIVnegative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity. Conclusions. Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study

Study of Viral Load as A Predictive Marker of the Evolution of HIV Type 2 Infection in Burkina Faso

BACKGROUND: HIV - 2 infection is characterized by low sexual and vertical transmission and slow clinical and immunological progression. However, it can lead to AIDS. Viral load measurement is a predictive test of the success or failure of antiretroviral therapy. In order to evaluate the efficacy of ARV treatment, we measured plasma viral load, and CD4 T - cell counts in 68 patients, of whom 56 were HIV - 2 infected and 12 were HIV - 1/HIV - 2 co - infected. METHOD: We tested EDTA plasma samples stored at - 80 ° C, taken from patients followed in sentinel sites in the city of Ouagadougou. The sera were obtained by centrifugation, and the plasmatic viral load quantified by droplet double polymerase chain reaction (dd PCR), at a detection threshold of 10 copies/ml. Sociodemographic, clinical and therapeutic data were collected from patients charts and completed during an interview. RESULTS: Patients had a mean age of 53.8 ± 7.8 years with extremes of [38 - 72 years] and were predominantly females (57.4%), with a sex ratio of 0.80. There was a predominance of housewives and married couples with respectively 36.8% and 75.0% of patients. The majority of patients (77.9%) were Category A, that is, they were either asymptomatic or in the primary infection phase. 22.0% of patients were symptomatic, with 13.2% and 8.8% respectively belonging to categories B and C. The most observed opportunistic infections were shingles found in 7.3% of patients, oral candidiasis found in 5.9%, signs of weight loss (undernutrition) in 5.9% and genital herpes in 1.5% of patients. Four patients (4.7%) had hepatitis B. One case of tuberculosis (1.5%) was reported. The therapeutic combination of protease inhibitors (Lopinavir / ritonavir) was the most prescribed (94, 1% of patients), 58.8% of the patients had a CD4 level < 500/mm3, and 41.2% had CD4 level ≥ 500 cells/mm3. Plasma viral load was undetectable (≤ 10 copies / ml) in 70.6% of patients, 7.3% had a viral load of 10 to 50 copies / ml, and 19.1% of patients had a high viral load (≥ 101 copies / ml). Our study showed that the highest CD4 levels are observed in patients with undetectable viral load (˂ 10copies / mL). This established that the CD4 cell count and the plasma viral load value move in the opposite direction, and are two predictors of the evolution of HIV infection, and the virological and / or immunological response to HAAR

Profil de sensibilité des souches de pneumocoques aux antibiotiques avant l’introduction du vaccin anti pneumococcique conjugué à treize valences (PCV-13) au Burkina Faso

Introduction: Streptococcus pneumoniae constitue un pathogène important des méningites bactériennes aiguës au Burkina Faso. Cela a justifié l’introduction du vaccin pneumococcique conjugué en Octobre 2013 dans le programme élargi de vaccination chez les enfants de moins d’un an. L’objectif de ce travail consiste à établir le profil de sensibilité aux antibiotiques des souches de S. pneumoniae isolées du liquide cérébro-spinal. Méthodologie: Du 1er Janvier 2010 au 30 Décembre 2012, 37 souches de pneumocoques ont été collectées du réseau national de surveillance de la méningite du pays. Ces souches, repiquées sur de la gélose au sang frais, ont été confirmées par le test de sensibilité à l’optochine. Le test de Quellung a déterminé les sérotypes de pneumocoques et l’antibiogramme a été réalisé selon la méthode de diffusion et interprété selon le standard « European Committee of antibiotics susceptibility testing. Résultats: Sur 37 isolats sérotypés, 77% appartenaient aux sérotypes vaccinaux. L’antibiogramme a révélé que 92% des souches sensibles à l’oxacilline, 97% à l’érythromycine et 73% à la clindamycine. Le cotrimoxazole a été actif dans 14% et la tétracycline seulement 5% des souches. Conclusion: La majorité des souches de pneumocoques isolée des méningites au Burkina Faso appartiennent aux sérotypes vaccinaux. Mots clés: Sensibilité; Antibiotiques; Pneumocoques; PCV-13 English Title: Profile of antibiotics susceptibility testing of pneumococcal strains before the introduction of the thirteen-valent conjugate pneumococcal vaccine (PCV-13) in Burkina Faso English Abstract&nbsp; Introduction: Streptococcus pneumoniae is an important pathogen of acute bacterial meningitis in Burkina Faso. This justify the introduction of the thirteen-valent pneumococcal vaccine in October 2013 in the expanded program of immunization in children under one year old. The aim of this work is to establish the antibiotics susceptibility testing profile of strains of S. pneumoniae isolated from cerebrospinal fluid. Methods: From January 1st, 2010 to December 30th, 2012, 37 strains of pneumococci were collected from the country's national meningitis surveillance network. These strains, subcultured on fresh blood agar, were confirmed by the optochin susceptibility testing. The Quellung test made it possible by determining the pneumococcal serotypes and the antibiogram carried out according to the diffusion method and interpreted according to the standard "European Committee of antibiotics susceptibility testing”. Results: Of the thirty-seven typed isolates, 77% belonged to the vaccine serotypes. Susceptibility to antibiotics reports 92% of strains susceptible to oxacillin, 97% to erythromycin and 73% to clindamycin. Cotrimoxazole was active in 14% and tetracycline only 5% of the strains. Conclusion: The majority of pneumococcal strains isolated from meningitis in Burkina Faso belong to vaccine serotypes. Keywords: Antibiotics; susceptibility testing; Pneumococci; PCV-1