Discussion

We included 180 cases of meningitis out of 3958 hospitalisations in our department, representing a frequency of 4.5%. Our frequency is higher than that of other African authors, notably in Tunisia, Kammoun TH et al [8] (1.14%), in Senegal Ba ID [9] (3.45%) and in Mali Maiga et al [10] (1.07%). In contrast, Barry et al [11] in the Republic of Guinea and Essola et al [12] in the Republic of Gabon found a frequency of 13.8% and 7.6% respectively. We can deduce that bacterial meningitis remains a public health problem in our regions.

Children under 12 months of age were the most affected with 45%, followed by those aged 13-59 months with 27.2%. These results confirm those of Maiga et al [10] and Doumbia AK et al [13], who showed that bacterial meningitis affects all age groups, but electively children under 5 years of age, with 41.4%, 63% and 60% of cases respectively. The predominance of the condition in children under 5 years of age may be explained by the immaturity of the immune system, with children’s susceptibility to ear, nose and throat infections constituting the gateway for the germs responsible for meningitis.

Most of the patients (58.9%) came from families with a low socioeconomic status, and 50.6% had no medical insurance. These results are similar to those of Doumbia A K et al [13] who found 62%. The level of education, lack of employment, low income and parents’ lack of affiliation to a health insurance scheme have a negative influence on the care of sick children [13].

We found that 18.3% of our sample had not received any vaccine. Our rate was higher than that of Maiga et al [10] and Coulibaly et al [14], who recorded 12% and 6.8% respectively. According to the literature, vaccination is the best large-scale health success in terms of benefit-risk and a very low cost for the population [5]. COVID 19 had an impact on the entire healthcare system, relegating routine vaccinations to second place, hence the high rate of non-vaccination.The average consultation time was 7 days (extremes 2 and 12 days). This rate is similar to that of Doumbia AK et al [13] who found 7 ± 4.2 days (extremes 2 and 21 days). According to the literature, the prognosis depends on how early the diagnosis is made and the quality of management [15].

Convulsion was observed in 92.2% of patients, was generalised in 66.9% and focal in 33.1%. Our results are comparable to those of Coulibaly A [16] who found 60.9%, 93.8% and 6.2% respectively. These results contrast with the data in the literature [15]. Half of our patients were in stage I coma (50.8%). According to the literature, the risk of death or sequelae is increased if the patient has presented a convulsive state, focal neurological signs or an altered state of consciousness [15, 5].

Axial hypotonia was found in 68.9% of cases. Other signs were stiff neck (35.6%), bulging anterior fontanel (33.3%) and hyperaesthesia of the skin (53.3%). These neurological signs were important signs suggesting a strong suspicion of meningitis and should therefore lead to lumbar puncture. They were consistent with those described in the literature [15,11]. CSF culture enabled us to isolate Streptococcus pneumoniae (25.6%), Haemophilus influenzae b (14.4%) and Neisseria meningitidis (10.6%). Several authors confirm the presence of these three germs [10,11]. The presence of others: Escherichia coli (6.7%), Staphylococcus aureus (5.5%), Listeria monocytogenes (4.4%) and Salmonella (1.7%) was found by Diakité F [17] in 2016.  In our study, we found 71.8% Streptococcus pneumoniae, 80.8% Haemophilus influenzae b and 100% Escherichia coli and Listeria monocytogenes in children aged 1 to 12 months. Meningococcus was more frequent in children aged between 13 and 59 months (63.2%). This observation is common to all epidemiological studies of purulent meningitis, notably those of E. Bingen [1] and Tfifha M et al [18] in 2018 in Tunisia.

In order to detect acute complications, cerebral CT scans were performed in 58.3% of patients. Our rate is higher than that of Doumbia A K et al [13] who found 5.8%. It was not carried out systematically, but was indicated in cases of increased head circumference in infants under 2 years of age, impaired consciousness, persistent fever or signs of neurological deficit (persistent convulsive seizures, paralysis, visual impairment). Cerebral atrophy was the most frequently reported complication (17.8%), followed by hydrocephalus (5%), encephalitis (2.2%), subdural haematoma (2.2%) and meningeal haemorrhage (1.1%).

Conclusion

Despite the effectiveness of antibiotics (3rd generation cephalosporins), we observed a recovery rate without sequelae of 45% and a recovery rate with sequelae of 24.5%. The most common sequelae were axial hypotonia (54.6%) and hydrocephalus (20.5%). Other sequelae were abnormal movements (13.6%), deafmute (6.8%) and blindness (4.5%), 37% of which were associated with pneumococcus. The proportion of sequelae in all forms of the disease varies between 3% and 15% according to the literature [15,4,5].

The hospital case fatality rate remained high at 27.2%, and pneumococcus was the most lethal germ (30.4%). This observation has been reported by several authors [10, 19], and the long delay in consultation, the young age of our patients and, above all, the virulence of the germ could explain this high lethality associated with pneumococcus.

According to the literature, the main risk factors for death or sequelae are: age less than 2 years, prolonged delay in care, the existence of a coma during hospitalisation, the need for a stay in intensive care, hypoglycorrhagia, and the absence of corticosteroid therapy [15,5].

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