Aetiology of encephalitis and meningitis in children aged 1-59 months admitted to the children’s hospital, Lusaka, Zambia.

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Imamba, Akakambama
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The University of Zambia
Meningitis and encephalitis are important causes of admissions and mortality in Zambia. There is a worldwide geographical and regional variation in the causative agents. Apart from bacteria, little is known about viral agents that cause the disease in Zambia. To identify the viral and bacterial causative organisms, we conducted a prospective descriptive study at the Children’s Hospital, in Lusaka, Zambia. To determine the causative organisms of viral encephalitis and meningitis, and pyogenic meningitis; determine biochemical and cellular changes in cerebrospinal fluid (CSF) and the associated clinical features in children aged 1-59 months admitted at the Children’s Hospital, Lusaka. Between November 2016 and February 2018, we collected CSF samples and clinical details from children aged 1-59 months with meningitis and encephalitis who met the inclusion criteria. Macroscopic examination, microscopy, bacterial culture, real-time (Multiplex) PCR and biochemistry were performed on the CSF samples. A total of 106 children were enrolled. The female to male ratio was 1.2:1. The median age of the study patients was 10 months. There were 81 (76.4%) cases with meningitis and 25 (23.6%) with encephalitis. The median duration of symptoms was 3 days. There was only one (0.9%) participant with Haemophilus influenzae bacteria detected by both culture and PCR. Two (1.9%) cases had Neisseria meningitidis while 5 (4.7%) had Streptococcus pneumoniae detected only by PCR. Viruses were only detected in 26.4% (28/106) of the cases. The viral agents detected were Epstein-Bar virus (10%) and parvovirus B19, Human herpes virus type 6, Human herpes virus type 7 and CMV at 2.8% each. Viral agents were detected in 64% and 36% of patients with meningitis and encephalitis, respectively. Bacterial agents were detected in 75% and 25% of patients with meningitis and encephalitis respectively. Ninety percent of cases had a history of fever and 50% had a history of a seizure. A raised CSF white blood cell counts (WBC) was significantly associated with case definition of meningitis (P=0.01). Patients that were alive at discharge point had on average 3.6 times increased odds for meningitis case definition (OR = 3.6, CI = 1.96 – 6.68, P-value <0.001). Viral infections of the central nervous system (CNS) are the commonest causes of both encephalitis and meningitis in children aged 1-59 months admitted at the Children’s Hospital in Lusaka, Zambia. The causative agents were not significantly associated with a case definition of encephalitis or meningitis. A raised WBC was significantly associated with meningitis.
Thesis of Master of Medicine in Paediatrics and Child Health