Meningitis Agudas en Córdoba,Colombia 2002 - 2004

Confirmation of the presence of Angiostrongylus cantonensis in lung tissue of the African giant snail (Lissachatina fulica) in Colombia

Objetive: To confirm the presence of Angiostrongylus cantonensis in Lissachatina fulica individuals in Colombia.Methods: 19 individuals of L. fulica were collected in the city of Buenaventura, Valle del Cauca, Colombia. Lung tissue was extracted and two analysis methods were used: visual identification by histological observation, and identification through conventional and real-time PCR. The A. cantonensis detection rate was established taking into account each of the analysis techniques used.Results: Presence of A. cantonensis was confirmed in the lung tissue of L. fulica specimens collected in the city of Buenaventura, Valle del Cauca, Colombia. The detection rate based on visual identification through histological analysis was 89%, whereas it was 95% using conventional PCR, and 100% using real-time PCR.Conclusion: This study confirmed for the first time the presence of A. cantonensis associated with L. fulica specimens in Colombia. Therefore, eosinophilic meningitis could be considered an emerging disease in Colombia.

Bacterial meningitis and living conditions

INTRODUCTION

Bacterial meningitis has great social relevance due to its ability to produce sequelae and cause death. It is most frequently found in developing countries, especially among children. Meningococcal meningitis occurs at a high frequency in populations with poor living conditions. This study describes the temporal evolution of bacterial meningitis in Salvador, Brazil, 1995-2009, and verifies the association between its spatial variation and the living conditions of the population.

METHODS

This was an ecological study in which the areas of information were classified by an index of living conditions. It examined fluctuations using a trend curve, and the relationship between this index and the spatial distribution of meningitis was verified using simple linear regression.

RESULTS

From 1995-2009, there were 3,456 confirmed cases of bacterial meningitis in Salvador. We observed a downward trend during this period, with a yearly incidence of 9.1 cases/100,000 population and fatality of 16.7%. Children aged <5 years old and male were more affected. There was no significant spatial autocorrelation or pattern in the spatial distribution of the disease. The areas with the worst living conditions had higher fatality from meningococcal disease (β = 0.0078117, p < 0.005).

CONCLUSIONS

Bacterial meningitis reaches all social strata; however, areas with poor living conditions have a greater proportion of cases that progress to death. This finding reflects the difficulties for ready access and poor quality of medical care faced by these populations.

Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean: a systematic review and meta-analysis, 1990-2010

BACKGROUND

Pneumococcal conjugate vaccines (PCVs) are in the process of implementation in Latin America. Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease. However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A. We conducted a systematic review to determine the distribution of serotype 19A, burden of pneumococcal disease and antibiotic resistance in the region.

METHODS

We performed a systematic review of serotype 19A data from observational and randomized clinical studies in the region, conducted between 1990 and 2010, for children under 6 years. Pooled prevalence estimates from surveillance activities with confidence intervals were calculated.

RESULTS

We included 100 studies in 22 countries and extracted data from 63. These data reported 19733 serotyped invasive pneumococcal isolates, 3.8% of which were serotype 19A. Serotype 19A isolates were responsible for 2.4% acute otitis media episodes, and accounted for 4.1% and 4.4% of 4,380 nasopharyngeal isolates from healthy children and in hospital-based/sick children, respectively. This serotype was stable over the twenty years of surveillance in the region. A total of 53.7% Spn19A isolates from meningitis cases and only 14% from non meningitis were resistant to penicillin.

CONCLUSIONS

Before widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases. With increased use of PCVs and a greater number of serotypes included, monitoring S. pneumoniae serotype distribution will be essential for understanding the epidemiology of pneumococcal disease.

Population-based surveillance for invasive pneumococcal disease and pneumonia in infants and young children in Bogotá, Colombia

BACKGROUND

In children <5 years of age, Streptococcus pneumoniae (SP) is, globally, the leading cause of vaccine-preventable death. Surveillance conducted in Bogotá, Colombia estimated incidence rates of invasive pneumococcal disease (IPD), clinical and chest radiograph-confirmed pneumonia (CXR+Pn); SP serotype distribution and antimicrobial susceptibility.

METHODS

This prospective population-based surveillance was conducted from 2006 to 2008 in children 28 days to <36 months of age seeking care at SaludCoop centers. We determined incidence rates of IPD and pneumonia (clinical and CXR+Pn). Eligibility criteria included: temperature ≥39.0°C within 24h and/or clinical suspicion of IPD or pneumonia. Blood was obtained for culture in all children. Other sterile site specimens were obtained per routine practice.

RESULTS

Of 8261 subjects enrolled, a total of 64 had invasive pneumococcal disease detected by isolation of SP from nonduplicative cultures (62) or detected solely by PCR and a clinical picture consistent with IPD (2). The overall IPD incidence rates for culture-positive only cases for children aged 28 days to <36 months was 76.4/100,000 per year for years 1 and 2 combined. Age stratification found the highest rates in children 6-12 and 12 to <24 months of age. IPD incidence rates were assessed for bacteremic pneumonia (54.2/100,000), bacteremia (17.2/100,000), meningitis (3.7/100,000), and sepsis (1.2/100,000). Most common serotypes causing IPD were: 14 (51.6%), 6B (9.7%), and 19F (9.7%). Coverage of IPD cases by pneumococcal conjugate vaccine (PCV) 7, PCV10, and PCV13 was 77.4%, 85.5%, and 91.9%, respectively. Twenty-eight isolates (45.2%) were penicillin-nonsusceptible; PCV7 covered 96.3% of these; PCV10 covered 96.3% and PCV13 covered 100%. The overall incidence of clinical pneumonia and CXR+Pn was 6276/100,000 and 2120/100,000, respectively.

CONCLUSION

Pneumococcal disease and pneumonia burden is considerable in children in Bogotá, Colombia. Vaccination with pneumococcal conjugate vaccines has the potential to decrease this burden. Epidemiologic data are critical in assessing the potential impact of introduction of PCVs into national immunization schedules.

Clinical behavior of Streptococcus pneumoniae meningoencephalitis

OBJECTIVE

There was an increased number of cases of meningoencephalitis caused by Streptococcus pneumoniae, after the successful vaccination campaigns against Neisseria meningitidis and Haemophilus influenzae. This paper aims at describing the clinical characteristics, the laboratory findings, the complications, and the therapeutic management of these patients, who have been suffering from this disease since 1993 to 2006.

METHOD

Twelve children with Streptococcus pneumoniae meningoencephalitis admitted to the pediatric hospital of San Miguel del Padron, City of Havana in this period were assessed.

RESULTS

Children under one year are the most frequently affected. Septic shock and brain edema were the most severe complications. Three patients died, implying that this disease has a serious course. Early treatment of brain edema is very important to reduce mortality. The elective drugs for treatment of these cases of Streptococcus pneumoniae meningoencephalitis were vancomycin combined with cephalosporin, cefotaxime or ceftriaxone type.

CONCLUSION

Patients with Streptococcus pneumoniae meningoencephalitis show clinical characteristics, complications, and sequels that are different to other bacterial meningoencephalitis, meaning that they could be helpful for physicians considering the differential diagnosis of meningoencephalitis.