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International audience ; Bacterial meningitis remains an international public health threat. The most affected area worldwide is the Sahelian region between Senegal and Ethiopia called the meningitis belt. In parallel recurrent epidemics have also occurred out of the belt in Africa for the last twenty years. While environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. Based on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the Democratic Republic of Congo (DRC), we used different statistical methods to explore the links between meningitis cases and the different explored factors. Our results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from North to South in the DRC. This information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.

International audience ; Bacterial meningitis remains an international public health threat. The most affected area worldwide is the Sahelian region between Senegal and Ethiopia called the meningitis belt. In parallel recurrent epidemics have also occurred out of the belt in Africa for the last twenty years. While environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. Based on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the Democratic Republic of Congo (DRC), we used different statistical methods to explore the links between meningitis cases and the different explored factors. Our results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from North to South in the DRC. This information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.

International audience ; Bacterial meningitis remains an international public health threat. The most affected area worldwide is the Sahelian region between Senegal and Ethiopia called the meningitis belt. In parallel recurrent epidemics have also occurred out of the belt in Africa for the last twenty years. While environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. Based on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the Democratic Republic of Congo (DRC), we used different statistical methods to explore the links between meningitis cases and the different explored factors. Our results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from North to South in the DRC. This information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.

International audience ; Bacterial meningitis remains an international public health threat. The most affected area worldwide is the Sahelian region between Senegal and Ethiopia called the meningitis belt. In parallel recurrent epidemics have also occurred out of the belt in Africa for the last twenty years. While environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. Based on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the Democratic Republic of Congo (DRC), we used different statistical methods to explore the links between meningitis cases and the different explored factors. Our results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from North to South in the DRC. This information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.

International audience ; Bacterial meningitis remains an international public health threat. The most affected area worldwide is the Sahelian region between Senegal and Ethiopia called the meningitis belt. In parallel recurrent epidemics have also occurred out of the belt in Africa for the last twenty years. While environmental, socioeconomic and demographic factors are well described to explain the epidemiology of meningitis in the belt, very few studies have focused on the role of these factors to understand meningitis epidemics outside of the belt. Based on epidemiological, socio-economic, demographic and environmental data collected for the period 2000-2018 in the Democratic Republic of Congo (DRC), we used different statistical methods to explore the links between meningitis cases and the different explored factors. Our results showed that urbanized areas where populations have a low economic index of well-being, high latitude and longitude eastwards, medium to low altitude level, savannah-type vegetation, medium temperature value, are risk factors of meningitis outbreaks from North to South in the DRC. This information is important to help improving meningitis control strategies in a large country located outside the so-called meningitis belt.

AbstractIntroductionHIV‐associated cryptococcal, TB and pneumococcal meningitis are the leading causes of adult meningitis in sub‐Saharan Africa (SSA). We performed a systematic review and meta‐analysis with the primary aim of estimating mortality from major causes of adult meningitis in routine care settings, and to contrast this with outcomes from clinical trial settings.MethodsWe searched PubMed, EMBASE and the Cochrane Library for published clinical trials (defined as randomized‐controlled trials (RCTs) or investigator‐managed prospective cohorts) and observational studies that evaluated outcomes of adult meningitis in SSA from 1 January 1990 through 15 September 2019. We performed random effects modelling to estimate pooled mortality, both in clinical trial and routine care settings. Outcomes were stratified as short‐term (in‐hospital or two weeks), medium‐term (up to 10 weeks) and long‐term (up to six months).Results and discussionSeventy‐nine studies met inclusion criteria. In routine care settings, pooled short‐term mortality from cryptococcal meningitis was 44% (95% confidence interval (95% CI):39% to 49%, 40 studies), which did not differ between amphotericin (either alone or with fluconazole) and fluconazole‐based induction regimens, and was twofold higher than pooled mortality in clinical trials using amphotericin based treatment (21% (95% CI:17% to 25%), 17 studies). Pooled short‐term mortality of TB meningitis was 46% (95% CI: 33% to 59%, 11 studies, all routine care). For pneumococcal meningitis, pooled short‐term mortality was 54% in routine care settings (95% CI:44% to 64%, nine studies), with similar mortality reported in two included randomized‐controlled trials. Few studies evaluated long‐term outcomes.ConclusionsMortality rates from HIV‐associated meningitis in SSA are very high under routine care conditions. Better strategies are needed to reduce mortality from HIV‐associated meningitis in the region.

La meningitis por Neisseria meningitidis (N. meningitidis) o meningococo es poco común en México, los casos son esporádicos, los serogrupos B y C son los más frecuentes. La tipificación en algunos casos es difícil de realizar. Los mecanismos de patogenicidad, los factores del hospedero que influyen en la presentación clínica, en el pronóstico y la respuesta al tratamiento son analizados en esta revisión que presentamos a propósito de un caso clínico esporádico, tratado satisfactoriamente en el Hospital Central Militar, en el que se identificó N. meningitidis no tipificable.

Abstract
Meningitis remains a major health burden throughout Sahelian Africa, especially in heavily populated northwest Nigeria with an annual incidence rate ranging from 18 to 200 per 100 000 people for 2000–11. Several studies have established that cases exhibit sensitivity to intra- and interannual climate variability, peaking during the hot and dry boreal spring months, raising concern that future climate change may increase the incidence of meningitis in the region. The impact of future climate change on meningitis risk in northwest Nigeria is assessed by forcing an empirical model of meningitis with monthly simulations of seven meteorological variables from an ensemble of 13 statistically downscaled global climate model projections from phase 5 of the Coupled Model Intercomparison Experiment (CMIP5) for representative concentration pathway (RCP) 2.6, 6.0, and 8.5 scenarios, with the numbers representing the globally averaged top-of-the-atmosphere radiative imbalance (in W m−2) in 2100. The results suggest future temperature increases due to climate change have the potential to significantly increase meningitis cases in both the early (2020–35) and late (2060–75) twenty-first century, and for the seasonal onset of meningitis to begin about a month earlier on average by late century, in October rather than November. Annual incidence may increase by 47% ± 8%, 64% ± 9%, and 99% ± 12% for the RCP 2.6, 6.0, and 8.5 scenarios, respectively, in 2060–75 with respect to 1990–2005. It is noteworthy that these results represent the climatological potential for increased cases due to climate change, as it is assumed that current prevention and treatment strategies will remain similar in the future.

Se realizó un estudio retrospectivo, donde se evaluaron los resultados de las pruebas de laboratorio en líquido cefalorraquídeo (LCR) con sospecha de meningitis bacteriana (MB) en la totalidad de muestras procesadas durante el año de 1997, dichos estudios fueron: citoquímica, tinción de Gram, cultivos (estándar de oro), y coaglutinación. Para esta evaluación se utilizó el teorema de Bayes y para la significancia estadística se emplearon la prueba de Ji cuadrada y la correlación de Pearson. Los resultados fueron, que la sensibilidad para cada estudio es: citoquímica 95 %, tinción de Gram 57%, cultivo 100%, y coaglutinación 100%; la especificidad fue citoquímica 96%, tinción de Gram 99%, cultivo 100%, y coaglutinación 100%. Los datos obtenidos se acercan a los que la literatura ha expuesto hasta la fecha y estos estudios son por lo tanto un buen marcador en conjunto para el diagnóstico de meningitis bacteriana; estadísticamente presentan una significancia de (α= 0.05 y p = 0.095) y, su correlación no se aleja demasiado de la ideal (r = 0.87). Sobresale en este estudio, que la prueba de coaglutinación no debe solicitarse de modo rutinario debido a las indicaciones específicas para su uso.

During the 1983-84 school year, 3,618 students under age 18 years with hearing impairments caused by meningitis were reported to the Gallaudet Research Institute Annual Survey, accounting for 8.7 per cent of children in the survey under 18 years. This research suggests that universal vaccination at age 18 months could prevent at least 115 cases of hearing loss annually in the United States. Reported prevalence rates of hearing loss from meningitis are higher for blacks (.98 per 10 5 than for all hearing impaired students (.58 per 10 5 ) and higher for males (.68 per 10 5 ) than females (.48 per 10 5 ). Geographic differences are also observed. Among those students with hearing losses from meningitis, 86.7 percent lose their hearing prior to age 3 years, 62.6 percent has profound hearing loss and 22.7 percent manifested additional sequelae, most of which were neurological.

Felix Bongomin,1,2 Senai Goitom Sereke,3 Jerom Okot,2 Ronald Katsigazi,1 Tadeo Kiiza Kandole,4 Anthony Oriekot,5 Ronald Olum,1 Angella Atukunda,6 Joseph Baruch Baluku,5 Frederick Nakwagala6 1Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda; 3Department of Radiology and Radiotherapy, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 4Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; 5Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda; 6Department of Medicine, Mulago National Referral Hospital, Kampala, UgandaCorrespondence: Felix BongominDepartment of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, UgandaTel +256-784-523-395Email drbongomin@gmail.comBackground: Several viral, bacterial and fungal co-infections have been associated with increased morbidity and mortality among patients with COVID-19. We report a fatal case of severe COVID-19 pneumonia in a patient with a recent diagnosis of advanced HIV disease complicated by cryptococcal meningitis, disseminated tuberculosis and acute ischemic stroke.Case Presentation: A 37-year-old Ugandan woman was diagnosed with HIV infection 8 days prior to her referral to our center. She was antiretroviral naïve. Her chief complaints were worsening cough, difficulty in breathing, fever and altered mental status for 3 days with a background of a 1-month history of coughing with associated drenching night sweats and weight loss. The reverse transcriptase–polymerase chain reaction for SARS-CoV-2 of her nasopharyngeal swab sample was positive. Chest radiograph demonstrated military pattern involvement of both lungs. The serum and cerebrospinal fluid cryptococcal antigen tests were positive. Urine lipoarabinomannan and sputum GeneXpert were positive for Mycobacterium tuberculosis. Computed tomography of the brain showed a large acute ischemic infarct in the territory of the right middle cerebral artery. Regardless of the initiation of treatment, that is, fluconazole 1200 mg once daily, enoxaparin 60 mg, intravenous (IV) dexamethasone 6 mg once daily, oral fluconazole 1200 mg once daily, IV piperacillin/tazobactam 4.5 g three times daily and oxygen therapy, the patient passed on within 36 hours of admission.Conclusion: Co-infections worsen COVID-19 outcomes.Keywords: COVID-19, HIV, cryptococcal meningitis, stroke, tuberculosis, co-infection