Susecptibility Pattern Of Meningococcal Meningitis Outbreak In Nguru, Yobe State, North-Eastern Nigeria

RT Akuhwa; MA Alhaji; MA Bello; MY Buharafa; KO Okon

摘要

Background: The study area lies within meningitis belt, and epidemic outbreaks are common occurrence. Effective treatment of meningococcal meningitis depends on administration of appropriate antibiotics. The study reviewed the antibiotic susceptibility pattern of bacterial pathogens implicated in meningococcal meningitis in the study area.Methods: This is a retrospective study conducted during the epidemic period (January –May 2009). The CSF specimens were examined by standard bacteriological methodsResults: Of the 110 CSF specimen examined, 54 (49.1%) were positive by Gram-reaction, 32 (59.3%) yielded bacterial growth, with Niesseria meningitidis, 25 (78.1%), Strep. pneumoniae 4 (12.5), coliforms 2(6.3%), and S.aureus 1(3.1). Twelve of the 25 N. meningitidis were recovered from children aged less than 60 months with youngest less than 2 months. From the study the bacterial isolates were susceptible to ceftriaxone (100%), chloramphenicol (92.3%) and penicillin (50%) respectively.Conclusion; The high sensitivity of the organisms to ceftriaxone (100%) and chloramphenicol (92.3%) as observed in this study is in support of their use as first-line antibiotics in the treatment of epidemic meningococcal meningitis as advocated by the World Health Organization. Introduction The recent meningococcal outbreak is a continuum of an event observed in sub-Saharan Africa since 1840.1 Since the early 1900s, periodic large outbreaks of meningococcal meningitis have been experienced in Nigeria, which lies in the African meningitis belt. 1,2 Northern Nigeria has experienced five major epidemics of meningococcal meningitis in the last 40 years, 1970, 1975, 1977, 1986, 1996,3 and smaller other outbreaks.4 The 1996 epidemic was the severest, with over 11,717 deaths recorded.3 Epidemiological changing pattern of the meningococcal outbreaks, including susceptibility of Neisseria meningitidis (N. meningitidis) to antibiotics, has been reported over the years.3 - 6 World Health Organization (WHO) recommends the use of chloramphenicol and ceftriaxone as first-line drugs during outbreaks of meningococcal meningitis.7 Single intra-muscular injections of oily chloramphenicol have proven effective during outbreaks.1, 3 It has the advantage of being effective, cheap and it is easy to administer. However, resistance to chloramphenicol and a decreasing sensitivity pattern has been reported in some parts of the world.5 Parenteral penicillins have also been recommended in the treatment of meningococcal disease in the industrialized world.1, 8 From January to May 2009, there was an outbreak of meningococcal disease in Nguru and its environs, and oily chloramphenicol and ceftriaxone were widely used in the management of patients, in line with WHO recommendations.7 This study was undertaken to determine the suitability of such a recommendation in Nguru, in the face of reports of changing pattern of antibiotic sensitivity of N. meningitidis and also to determine the susceptibility of the bacteria to other commonly used antibiotics, such as penicillins. Patients and methods Federal medical centre Nguru is the only tertiary health centre in Yobe State that serves as a referral hospital and also for catchment areas such as Hadeja in Jigawa State. The hospital also serves patients from neighbouring country of Niger Republic. Nguru is an old commercial town, and is cosmopolitan. The major tribes of the town are Manga and Hausa. The results of all the cerebrospinal fluid (CSF) specimens obtained from children during the period of the meningococcal epidemic (January to May 2009) were retrieved from the register of the microbiology department and retrospectively studied. The name, hospital number, age, sex, date of analysis, Gram stain, Culture, antibiotic sensitivity and resistance of the isolates were extracted and analysed. Results A total of 110 CSF samples from children aged 2 months to 13 years were analysed. Gram stain was positive in 54(49.1%) and negative in 56(50.

机译：背景：研究区域位于脑膜炎带内，流行病流行。脑膜炎球菌性脑膜炎的有效治疗取决于给予适当的抗生素。该研究回顾了研究区域内与脑膜炎球菌性脑膜炎有关的细菌病原体的抗生素敏感性模式。方法：这是在流行期间（2009年1月至2009年5月）进行的一项回顾性研究。结果：在110份CSF标本中，革兰氏反应阳性的有54份（49.1％），细菌生长的有32份（59.3％），脑膜炎奈瑟氏菌有25份（78.1％），链球菌。肺炎4（12.5），大肠菌2（6.3％）和金黄色葡萄球菌1（3.1）。 25例脑膜炎奈瑟氏菌中有12例是从年龄小于60个月的儿童中恢复的，最小的是小于2个月的儿童。从该研究中分离出的细菌分别对头孢曲松（100％），氯霉素（92.3％）和青霉素（50％）敏感。在这项研究中观察到，该生物体对头孢曲松（100％）和氯霉素（92.3％）的高度敏感性，证明了它们被用作世界卫生组织所倡导的一线抗生素，用于治疗流行性脑膜炎球菌性脑膜炎。简介最近的脑膜炎球菌暴发是自1840.1年以来在撒哈拉以南非洲观察到的一个事件的连续发生。自1900年代初以来，在非洲脑膜炎带中的尼日利亚经历了周期性的大规模脑膜炎球菌性脑膜炎暴发。 1,2在过去的40年中，尼日利亚北部北部经历了五次主要的脑膜炎球菌性脑膜炎流行，1970年，1975年，1977年，1986年，1996年，3和其他较小的爆发。41996年的流行是最严重的，记录了11717例死亡。3多年来已经报道了脑膜炎球菌暴发的流行病学变化模式，包括脑膜炎奈瑟氏球菌（N. meningitidis）对抗生素的敏感性。3-6世界卫生组织（WHO）建议在此期间使用氯霉素和头孢曲松作为一线药物脑膜炎球菌性脑膜炎的爆发。7肌肉注射油性氯霉素在爆发期间已被证明是有效的。1、3它具有有效，便宜且易于管理的优点。但是，在世界某些地方，已报道了对氯霉素的抗药性和敏感性下降的趋势。5在工业化国家，也推荐使用肠胃外青霉素治疗脑膜炎球菌疾病。1、8 2009年1月至5月，面对世界卫生组织的建议，乌鲁鲁及其周边地区爆发脑膜炎球菌病，并广泛使用油性氯霉素和头孢曲松酮治疗患者。7面对尼古拉，本研究旨在确定这种建议在乌鲁鲁的适用性。报道了脑膜炎奈瑟氏菌对抗生素敏感性的变化模式，并确定了细菌对其他常用抗生素（如青霉素）的敏感性。患者和方法Nguru联邦医疗中心是Yobe州唯一的三级医疗中心，既可以作为转诊医院，也可以服务于集川地区Hadeja等集水区。该医院还为来自邻国尼日尔共和国的患者提供服务。恩古鲁（Nguru）是一座古老的商业小镇，具有国际化气息。该镇的主要部落是漫画和豪萨。脑膜炎球菌流行期间（2009年1月至2009年5月）从儿童身上获得的所有脑脊液（CSF）标本的结果均从微生物学部门的登记册中检索并进行了回顾性研究。提取并分析分离株的名称，医院编号，年龄，性别，分析日期，革兰氏染色，培养，抗生素敏感性和耐药性。结果共分析了110例2个月至13岁儿童的CSF样本。革兰氏染色阳性的占54（49.1％），阴性的占56（50）。

Susecptibility Pattern Of Meningococcal Meningitis Outbreak In Nguru, Yobe State, North-Eastern Nigeria

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