Identification of Streptococcus suis Meningitis through Population-Based Surveillance, Togo, 2010-2014.

During 2010-2014, we enrolled 511 patients with suspected bacterial meningitis into surveillance in 2 districts of northern Togo. We identified 15 persons with Streptococcus suis infection; 10 had occupational contact with pigs, and 12 suffered neurologic sequelae. S. suis testing should be considered in rural areas of the African meningitis belt

Etude descriptive de l’epidemie de la meningite bacterienne survenue dans le District Sanitaire de Dankpen au Togo durant la periode de Janvier a Mai 2016 : apparition de la souche neisseria meningitidis W135.: Descriptive study of the bacterial meningitis epidemic occurring in the Health District of Dankpen in Togo during the period from January to May 2016 : appearance of the neisseria meningitidis strain W135.

Objectif : Cette étude a pour objectif de décrire l’épidémie de méningite survenue dans le district de Dankpen, au nord-ouest de la région de la Kara (Togo) durant la période de Janvier à Mai 2016.Méthode : Des fiches de données de chaque patient ont été consultées et les résultats des analyses bactériologiques portant sur l’identification des germes responsables en utilisant les techniques de coloration de GRAM, de culture et d’agglutination au latex ont été également collectés.Résultat : Trois cent soixante-cinq (365) cas suspects de méningite ont été notifiés dans le district sanitaire de Dankpen avec une prévalence élevée chez les enfants (72,88%). La répartition des cas selon le sexe est presque équitable soit 50,14% pour le sexe masculin et 49,86% pour le sexe féminin. Cinq (05) formations sanitaires ont enregistré le plus grand nombre de cas suspects avec des fréquences de 34,52 % pour le CHP de Guérin-Kouka, 12,05% pour l’USP de Naware, 8,76% pour l’USP de Kidjaboun, 7,94%pour l’USP Solidarité et 6,85% pour l’USP de Nampoch. Les analyses biologiques ont permis de révéler 37cas positifs au Neisseria meningitidis W135 et un cas positif au Streptococcus pneumoniae.L’épidémie a causé 15 décès surtout chez les enfants qui ont été positifs au Neisseria meningitidis W135 à un taux de 12,78%.Conclusion : Cette épidémie a été essentiellement marquée par l’émergence de la souche de Neisseria meningitidis W135. Elle a été le point de départ d’une épidémie qui a touché toute la région de la Kara, amenant ainsi les autorités sanitaires à prendre des dispositions incluant la couverture de toute la zone affectée et des zones environnantes par de nouveaux vaccins anti-méningite.ABSTRACT:Aim: This descriptive study aims to describe the meningitis epidemic that occurred in the district of Dankpen, northwest of the region of Kara (Togo) during the period January to May 2016.Method: Data sheets for each patient were consulted and results of bacteriological analyzes on identification of causative organisms using GRAM staining, culture and latex agglutination techniques were also collected.Result: Three hundred and sixty-five (365) suspected cases of meningitis were reported in the Health District of Dankpen with a high prevalence among children (72.88%). The distribution of cases by sex is almost equitable, at 50.14% for males and 49.86% for females. Five (05) health facilities recorded the highest number of suspected cases with frequencies of 34.52% for Guérin-Kouka CHP, 12.05% for Naware USP, 8.76% for USP of Kidjaboun, 7.94% for the USP Solidarity and 6.85% for the USP of Nampoch. The biological analyzes revealed 37 positive cases for Neisseria meningitidis W135 and one positive case for Streptococcus pneumoniae. The epidemic caused 15 deaths, especially among children who were positive for Neisseria meningitidis W135 at a rate of 12.78%.Conclusion: This epidemic was essentially marked by the emergence of the Neisseria meningitidis strain W135. It was the starting point for an epidemic that affected the entire Kara region and allowed health authorities to make arrangements including coverage of the entire affected area and surrounding areas with new meningitis vaccines

Evaluation of chest radiography, lytA real-time PCR, and other routine tests for diagnosis of community-acquired pneumonia and estimation of possible attributable fraction of pneumococcus in northern Togo

International audienceStreptococcus pneumoniae (Spn) is a leading cause of community-acquired pneumonia (CAP), yet existing diagnostic tools remain inadequate. We aimed to evaluate laboratory and radiological methods for detecting pneumococcal aetiology in CAP patients and to estimate Spn prevalence in this group. All-aged patients hospitalized with clinically defined CAP in northern Togo were enrolled during 2010-2013. Latent class analysis pooled results of semi-automated blood culture (SABC), whole blood lytA real-time polymerase chain reaction (rt-PCR), serum C-reactive protein (CRP), and chest radiography (CXR) and categorized patients as likely pneumococcal or non-pneumococcal CAP. We enrolled 1684 patients; 1501 had results for all tests. CXR, SABC, lytA rt-PCR and CRP >71·2 mg/l had sensitivities of 94% [95% confidence interval (CI) 87-100], 13% (95% CI 10-16), 17% (95% CI 14-21) and 78% (95% CI 75-80), and specificities of 88% (95% CI 84-93), 100% (95% CI 99-100), 97% (95% CI 96-99) and 77% (95% CI 75-79), respectively. Pneumococcal attributable proportion was 34% (95% CI 32-37), increasing with age and in men. We estimated that Spn caused one third of CAP. Whole blood lytA rt-PCR was more sensitive than SABC; both had low sensitivity and high specificity. Conversely CXR was highly sensitive and reasonably specific; it could be a useful tool for epidemiological studies aiming to define Spn pneumonia incidence across all ages

Standardizing surveillance of pneumococcal disease

Background. Surveillance for invasive pneumococcal disease has been conducted using a variety of case ascertainment methods and diagnostic tools. Interstudy differences in observed rates of invasive pneumococcal disease could reflect variations in surveillance methods or true epidemiological differences in disease incidence. To facilitate comparisons of surveillance data among countries, investigators of Pneumococcal Vaccines Accelerated Development and Introduction Plan-sponsored projects have developed standard case definitions and data reporting methods. Methods. Investigators developed case definitions for meningitis, pneumonia, and very severe disease using existing World Health Organization guidelines and clinical definitions from Africa and Asia. Standardized case definitions were used to standardize reporting of aggregated results. Univariate analyses were conducted to compare results among countries and to identify factors contributing to detection of Streptococcus pneumoniae. Results. Surveillance sites varied with regard to the age groups targeted, disease syndromes monitored, specimens collected, and laboratory methods employed. The proportion of specimens positive for pneumococcus was greater for cerebrospinal fluid specimens (1.2%-19.4%) than for blood specimens (0.1%-1.4%) in all countries (range, 1.3-38-fold greater). The distribution of disease syndromes and pneumonia severity captured by surveillance differed among countries. The proportion of disease cases with pneumococcus detected varied by syndrome (meningitis, 1.4%-10.8%; pneumonia, 0.2%-1.3%; other, 0.2%-1.2%) and illness severity (nonsevere pneumonia, 0%-2.7%; severe pneumonia, 0.2%-1.2%), although these variations were not consistent for all sites. Antigen testing and polymerase chain reaction increased the proportion of cerebrospinal fluid specimens with pneumococcus identified by 1.3-5.5-fold, compared with culture alone. Conclusions. Standardized case definitions and data reporting enhanced our understanding of pneumococcal epidemiology and enabled us to assess the contributions of specimen type, disease syndrome, pneumonia severity, and diagnostic tools to rate of pneumococcal detection. Broader standardization and more-detailed data reporting would further improve interpretation of surveillance results. © 2009 by the Infectious Diseases Society of America. All rights reserved