Mengistu Mebratenesh, Asrat Daniel, Woldeamanuel Yimtubezinash, Mengistu Getahun
Department of Microbiology & Parasitology, Addis Ababa University, Faculty of Medicine, Addis Ababa.
Ethiop Med J. 2011 Oct;49(4):349-59.
Meningitis is usually caused by viral, bacterial or fungal pathogens. Bacterial meningitis is a medical emergency and if untreated has a high mortality rate. Even among those who survive the infection, some may develop permanent neurological disorders.
This study was undertaken to isolate and identify the bacterial and fungal etiologic agents of meningitis and to access the susceptibility pattern of bacterial isolates.
During the period of November 2007 to June 2008, 340 cerebrospinal fluid (CSF) specimens were obtained from suspected cases of meningitis admitted to Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. Microbiological analysis was performed on CSF specimens using standard procedures.
Of the 340 patients investigated, 53.5% were males and 46.5% were females. Over half of the patients (51.2%) were children (1 month to 16 years) and the remaining 32.6% and 16.2% were neonates (below 1 month of age) and adults (above 16 yrs of age), respectively. Fever was the commonest clinical feature observed in all age groups. Of the 340 CSF specimens, 26 (7.6%) had a positive bacterial or fungal culture. Bacterial isolates accounted for 84.6% of the total isolates. Among the bacteria, Streptococcus pneumoniae accounted for 36.4% followed by Haemophilus influenzae type b (Hib) and Nessieria meningitidis (serogroup A and C) (13.6%) each. Cryptococcus neoformans was the only fungal isolate. All gram positive bacteria were sensitive to ceftriaxone, ciprofloxacin, chloramphenicol, erythromycin and rifampicin and showed low level of resistance (< 60%) to penicillin, tetracycline and trimethoprim-sulphamethoxazole. The gram-negative bacteria showed high level of resistance (> 80%) to tetracycline and trimethoprim-sulphamethoxazole, intermediate level of resistance (60-80%) to ampicilin and low level of resistance (< 60%) to ceftriaxone, ciprofloxacin, gentamicin, chloramphenicol and rifampicin. Multiple resistance (resistance to two or more drugs) was observed in 18.2% and 100% gram positive and gram-negative bacteria, respectively.
This study showed that the predominant pathogens of meningitis were S. pneumoniae, H. influenzae and N. meningitidis. Ceftriaxone and ciprofloxacin were the most effective drugs against these organisms. Continuous periodic surveillance is required to form a comprehensive and updated understanding of the etiologies and antimicrobial resistance pattern for appropriate management of meningitis cases in the country.
脑膜炎通常由病毒、细菌或真菌病原体引起。细菌性脑膜炎是一种医疗急症，若不治疗，死亡率很高。即使在感染后存活下来的患者中，有些人也可能会出现永久性神经障碍。
本研究旨在分离和鉴定脑膜炎的细菌和真菌病原体，并了解细菌分离株的药敏模式。
在2007年11月至2008年6月期间，从埃塞俄比亚亚的斯亚贝巴提库尔安贝萨大学医院收治的疑似脑膜炎病例中获取了340份脑脊液（CSF）标本。使用标准程序对CSF标本进行微生物学分析。
在340名接受调查的患者中，53.5%为男性，46.5%为女性。超过一半的患者（51.2%）为儿童（1个月至16岁），其余32.6%和16.2%分别为新生儿（1个月以下）和成年人（16岁以上）。发热是所有年龄组中最常见的临床特征。在340份CSF标本中，26份（7.6%）细菌或真菌培养呈阳性。细菌分离株占总分离株的84.6%。在细菌中，肺炎链球菌占36.4%，其次是b型流感嗜血杆菌（Hib）和脑膜炎奈瑟菌（A群和C群）（各占13.6%）。新型隐球菌是唯一的真菌分离株。所有革兰氏阳性菌对头孢曲松、环丙沙星、氯霉素、红霉素和利福平敏感，对青霉素、四环素和复方新诺明的耐药率较低（<60%）。革兰氏阴性菌对四环素和复方新诺明的耐药率较高（>80%），对氨苄西林的耐药率中等（60 - 80%），对头孢曲松、环丙沙星、庆大霉素、氯霉素和利福平的耐药率较低（<60%）。革兰氏阳性菌和革兰氏阴性菌的多重耐药率（对两种或更多药物耐药）分别为18.2%和100%。
本研究表明，脑膜炎的主要病原体是肺炎链球菌、流感嗜血杆菌和脑膜炎奈瑟菌。头孢曲松和环丙沙星是针对这些病原体最有效的药物。需要持续进行定期监测，以全面、更新地了解病因和抗菌药物耐药模式，以便对该国的脑膜炎病例进行适当管理。
