Meningitis - Meningokokken / Pneumokokken

[Alexander]

Neuer Impfstoff könnte Hirnhautentzündungen in Afrika verhindern

Mit einem neuen preiswerten Impfstoff will die Weltgesundheitsorganisation (WHO) in Afrika künftig die Verbreitung gefährlicher Hirnhautentzündungen verhindern. Eine Studie habe ergeben, dass der neu entwickelte Impfstoff den bislang wirksamsten Schutz vor einer Infektion mit Meningokokken-Bakterien des verbreitesten und gefährlichsten Typs A biete, teilte die WHO am Freitag in Genf mit. Mit einem Preis von gerade mal 0,30 Euro pro Dosis sei der Impfstoff, der mit der US-Organisation PATH entwickelt wurde, zudem sehr preiswert. mehr...

Grüsse
Alexander

[Alexander]

Rotes Kreuz warnt vor Meningitis-Epidemie in Afrika

In Afrika droht Anfang des Jahres eine gefährliche Meningitis-Epidemie. Wie die Föderation der Rote-Kreuz- und Roter-Halbmond-Verbände in Genf mitteilte, sind 14 Staaten des Kontinents von Masseninfektionen mit Meningokokken bedroht. mehr...

Grüsse
Alexander

[Birgitt]

Informationen zu Meningitis HIER

[Birgitt]

Nachfolgender Artikel betrifft zwar die USA, da das Thema "Meningitis" hier in Europa allerdings auch immer aktueller wird, und sich die Frage der "Antibiotika-Resistenz" auch hier immer häufiger stellt, ist dieser Artikel vielleicht doch für den ein oder anderen von Euch interessant:


MENINGITIS, MENINGOCOCCAL - DRUG-RESISTANT - USA (MINNESOTA, NORTH DAKOTA)
**************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 9 Feb 2008
Source: Pioneer Press [edited]
<http://www.twincities.com/ci_8213242?source=rss>


The nation's 1st known cases of antibiotic-resistant meningococcal
disease surfaced in northwest Minnesota and eastern North Dakota over
the past year [2007], according to the Minnesota Department of Health.
Health authorities on Friday [8 Feb 2008] asked doctors in the Fargo
[North Dakota]/Moorhead [Minnesota] area to stop using ciprofloxacin
for preventive treatment of people in close contact with
meningococcal patients and to use antibiotics outside the quinolone family.

The drug-resistant strains are the latest evidence of antibiotic
overuse, particularly in patients whose colds are viral and not
bacterial. "Even though there are other drugs that can be used to
prevent meningococcal disease, having one less weapon in our arsenal
reminds us of the importance of appropriate antibiotic use," said
Dr. Ruth Lynfield, state epidemiologist.

The 2 Minnesota cases turned up last month [January 2008], one
involving a 53-year-old from Marshall County [Minnesota] who died and
a 2nd involving a 22-year-old student at Minnesota State
University-Moorhead. The North Dakota case in January 2007 involved a
child at a Fargo daycare facility. The bacterial strains in all 3
cases are similar, but the patients had no known connections. Health
officials believe these strains are simply circulating in the region.
As many as 15 percent of people can have a meningococcal bacteria in
their throats or noses at any given time, but only a few suffer
severe infections.

Federal officials have been anticipating such a case. An official
from the U.S. Centers for Disease Control and Prevention (CDC)
traveled to the region Thursday [7 Feb 2008] and was taking random
throat swabs in an attempt to find someone carrying the
drug-resistant bacteria.

Close friends of the patients have been treated as a precaution, so
the CDC official will go to college campuses, bars and other
high-traffic locations. The infected student took music lessons, so
other music students might be tested, said Richard Danila, assistant
state epidemiologist. Danila stressed that these 1st cases are
significant but shouldn't worry the general public or cause people to
demand preventive treatment.

That the strain in the 53-year-old who died was drug-resistant didn't
factor into the fatality, Danila said, as patients with the infection
aren't treated with ciprofloxacin. All 3 patients developed
meningitis, a swelling of the brain and spinal cord, and required
hospital care. Minnesota is one of a dozen or so states that test
meningococcal strains for antibiotic resistance. That partly explains
why the 1st case was discovered here.

[Vaccination for meningococcal meningitis is] recommended for the
11-18 age group and for college freshmen [age 18-20. - Mod.JW]. While
a vaccine protects against two-thirds of these bacterial infections,
it wouldn't have worked against this particular strain. The vaccine is
recommended for children ages 11 to 18 and college freshmen.
Meningitis cases are somewhat rare, with an average of 24 per year
since 2000 in Minnesota. A total of 22 deaths have been linked to the
bacterial infection from 2000 through 2006 in the state, 10 of them
involving people 23 or younger.

****The antibiotic-resistant cases reported Friday [8 Feb 2008] were
the 1st on
record in the USA.*****

[Byline: Jeremy Olson]
--
Communicated by:
ProMED Rapporteur Brent Barrett

[Invasive meningococcal disease (bacteremia and meningitis) is a
contagious bacterial infection caused by _Neisseria meningitidis_.
_N. meningitidis_ colonizes the nasopharynx, and is spread by
respiratory droplets. Household members and other close contacts who
may be exposed to the index case's respiratory excretions have the
highest documented risk of secondary disease during the 1st 7 days of
a case being detected. Chemoprophylaxis is recommended for those in
close contact with a person with a meningococcal infection to prevent
secondary cases by eradicating _N. meningitidis_ from the
nasopharynx. Chemoprophylaxis is also used to cover the delay between
vaccination and the development of protective antibodies.

Chemprophylactic agents include rifampin, ciprofloxacin, and
ceftriaxone. Emergence of rifampin-resistance has been reported
following chemoprophylactic use of rifampin (Fraser A, et al.
Antibiotics for preventing meningococcal infections. Cochrane
Database Syst Rev. 2006 Oct 18;(4):CD004785). These authors raised
concerns about the clonal spread of these resistant isolates;
however, rifampin-resistant isolates are rarely reported (Taha M-K,
et al. Rifampin-resistant Neisseria meningitidis. (LETTERS). Emerging
Infectious Diseases 2006; 12:859-60).

Fluoroquinolone-resistance is usually due to accumulation of point
mutations in the genes (e.g., gyrA and parC genes) encoding DNA
gyrase and topoisomerase IV, the targets for these antimicrobial
agents. There are 5 previous reports of sporadic instances of
decreased susceptibility to ciprofloxacin due to point mutations in
the quinolone resistance determining region (QRDR) of the gyrA gene:
1) Serogroup B isolate with decreased susceptibility to ciprofloxacin
in the nasopharynx of a Parisian STD clinic patient in 1999 and 2) in
the CSF of a child in Spain in 2002 (Alcala B, et al. _Neisseria
meningitidis_ showing decreased susceptibility to ciprofloxacin: 1st
report in Spain. J Antimicrob Chemother. 2004;53:409); 3) Serogroup C
isolate in blood and CSF of a nursing student in Australia in 1998
(Shultz TR et al. Antimicrob Agents Chemother 2000; 44:1116); 4)
Serogroup Y and B from 2 patients in Argentina in 2002 (Corso A, et
al. Emergence of _Neisseria meningitidis_ with decreased
susceptibility to ciprofloxacin in Argentina. J Antimicrob Chemother
2005;55:596-7); and 5) Serogroup A in 12 of 14 strains from a 2005
outbreak in Delhi, India
(<http://www.cdc.gov/EID/content/13/10/1614.htm>).

The above news release states that infection due to the strain
involved in the 3 U.S.A. cases could not be prevented by vaccination.
Because vaccines are available for serogroups A, C, Y, and W-135, we
can assume that the strain involved in these 3 cases was serogroup B
for which there is no an effective vaccine. The news release also
states that the 3 strains were "similar;" but does not say if this
was on the basis of DNA fingerprinting, which would be helpful to
identify an expansion of a single clone in the community.

The news release intimates that the strains were susceptible to drugs
used to treat meningococcal meningitis, which include the 3rd
generation cephalosporins (ceftriaxone and cefotaxime), penicillin,
and chloramphenicol. Relative resistance to penicillin has been
infrequently reported due to decreased affinity of target
penicillin-binding proteins for penicillin and less commonly to
beta-lactamase production. Rare isolates that are
chloramphenicol-resistance have been reported (N Engl J Med 1998;
339:368-74 & 917-8).

Horizontal exchange of genes that encode resistance for penicillin,
rifampin and the fluoroquionolones from other _Neisseria_ species
that share a common ecological niche with _N. meningitidis_ in the
nasopharynx has been proposed as one possible mechanism acquisition
of meningococcal antibiotic resistance
(<http://jac.oxfordjournals.org/cgi/content/full/49/3/545>).

A map that locates Fargo, ND, and northwest Minnesota can be found at
<http://healthmap.org/promed?v=40,-97.6,4>. - Mod.ML]

[Birgitt]

Meningococcal disease in the African Meningitis Belt
Epidemiological situation: low levels of meningitis activity so far in 2008
WHO - 22.02.2008

The WHO Multi-Disease Surveillance Centre in Ouagadougou (MDSC - Burkina Faso) is monitoring the meningitis situation in the African meningitis belt throughout the epidemic season and in particular, in 13 countries under enhanced seasonal surveillance: Benin, Burkina Faso, Cameroon, the Central African Republic, Chad, Côte d'Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Mali, Niger, Nigeria and Togo.

Preliminary reports from these countries are of a total of 2,312 cases (324 deaths) occurring between 1 January and 10 February 2008. These figures are 29% lower than those reported in the same 6 week period in 2007 (3,274 cases, 413 deaths) indicating lower levels of meningitis activity so far in 2008.

Among countries reporting cases to the MDSC, Burkina Faso, the Central African Republic and the Democratic Republic of the Congo have been reporting outbreaks since the beginning of the season. Other countries reporting meningitis activity without reaching the epidemic threshold at district level include Benin, Côte d'Ivoire, Ethiopia, Ghana, Mali, Niger, Nigeria and Togo. Cameroon and Chad have not reported any cases.

Burkina Faso is the most affected country with a total of 1,422 cases, including 204 deaths (case fatality ratio- 14.3%) reported from 1 January to 10 February. These cases represent more than 61% of all cases reported to MDSC in 2008 (against 64% for the same period in 2007)

Neisseria meningitidis A (Nm A) was identified as the causative agent in Mangodara and Sapouy districts. Vaccination was carried out in these districts as well as in Gaoua, targeting the 2 to 29-year-old population. A cross border assessment is being carried out on the situation in Ivory Coast in the area neighbouring Mangodara district. Although the epidemiological trend in Burkina Faso is similar to the one observed last year, the first 6 weeks of 2007 saw more cases reported in total as well as more districts reaching the epidemic threshold (8 as against 2 in 2008).

The Ministry of Health in the Central African Republic is launching reactive mass vaccination campaigns in some of the communes that have reached the epidemic threshold in the Northern prefecture of Nana-Gribizi. A total of 45 cases, including 5 deaths (CFR 11.1%) had been reported by the end of week 6 and Nm A has been identified as the responsible pathogen. International partners including WHO and the International Coordination Group (ICG) are providing support for the vaccination campaigns.

In the Democratic Republic of the Congo1 a situation assessment is being carried out in Aru district that neighbours Arua district in Uganda) where 167 cases, including 17 deaths (CFR 10.2%) were reported during the period from 1 January to 10 February 2008. The most affected areas include Laybo, Ariwara and Aungba health zones. The Aru district also experienced an outbreak in early 2007.

Situation in other countries of the meningitis belt
In Southern Sudan a situation assessment is being carried out in areas where suspected cases were reported including in Awerial, Bor, Jur River and Torit Counties.

Uganda experienced an outbreak in Arua district West Nile region, with a total of 380 cases, including 17 deaths (CFR 4.5%) reported from 13 December 2007 to 28 January 2008. A sharp decline in the weekly case count was observed following a mass vaccination campaign that was implemented in week 04.

No suspected cases have been reported from other countries within the meningitis belt, namely Eritrea, Guinea, the Gambia, Kenya, Mauritania and Senegal.

Vaccine availability through the ICG
So far in 2008, the ICG has provided 40,000 vaccine doses, injection material and safety disposal boxes for vaccination campaigns in the Central African Republic.

The current ICG stockpile, available of outbreak response in this meningitis season stands at 7 million doses of bivalent polysaccharide A/C vaccine and 3.3 million doses of trivalent polysaccharide vaccine A/C/W135.

[Birgitt]

Meningitis-Impfungen für Afrika
Gesundheitsnews - 06.09.2008

Die medizinische Versorgung in Afrika ist ein Problem, nicht nur bei schwerwiegenden Krankheiten wie Aids. Auch Malaria und Meningitis können für einen Afrikaner unter Umständen das Todesurteil sein. Mit einer Impfkampagne will die Weltgesundheitsorganisation gegen Meningitis vorgehen. Sie soll etwa 250 Millionen Menschen erreichen ... mehr

Gruß
Birgitt

[Alexander]

Meningitis-Schutz ist auch für Jugendliche nötig

NEU-ISENBURG (eb). Am Samstag, 25. April, wird beim ersten Welt-Meningitis-Tag mit vielen Aktionen auf die mitunter fatalen Folgen einer Hirnhautentzündung hingewiesen. Zugleich wird dazu aufgerufen, beim Arzt nach Impfungen gegen Meningitis zu fragen und Impflücken zu schließen. mehr...


Mädchen verliert Beine nach Meningitis

KÖLN (dpa). Es begann mit Fieber, grippeähnlichen Symptomen, kleinen Flecken am Hals. Wenige Stunden später läuft die kleine Tamara am ganzen Körper lila an, fällt ins Koma. Akute Lebensgefahr, Niere, Lunge, Leber versagen, Bluttransfusionen, drei Wochen Intensivstation, Amputation beider Beine unterhalb der Knie sowie einiger Finger. Acht Monate in Kliniken und Rehas folgen. Die Zweijährige hatte eine Hirnhautentzündung. mehr...

Grüsse
Alexander

[Alexander]

Ein Tag mit den Meningitis-Impfteams in Niger

Im schlimmsten Meningitis-Ausbruch Westafrikas seit langer Zeit haben Teams von Ärzte ohne Grenzen in den vergangenen vier Monaten in Zusammenarbeit mit den lokalen Gesundheitsministerien etwa 7,5 Millionen Menschen geimpft und viele infizierte Patienten behandelt.

Bilderserie



Grüsse
Alexander

[Alexander]

Flughunde könnten gefährliches Virus verbreiten

Afrikanische Flughunde könnten Viren verbreiten, die schwere Gehirn- und Hirnhautentzündungen verursachen. Zu diesem Schluss kommen Bonner Forscher nach einer Studie in Ghana. Hendra- und Nipahviren (Henipaviren) gehören zu den gefährlichsten Krankheitserregern beim Menschen. mehr...

Grüsse
Alexander

[Birgitt]

MENINGITIS, PNEUMOCOCCAL - AFRICA: WHO MENINGITIS REGION
********************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 10 Feb 2010
Source: Reliefweb [edited]
<http://reliefweb.int/rw/rwb.nsf/db900SI ... enDocument>


Background: Pneumococcal conjugate vaccine strategies in GAVI [Global
Alliance for Vaccines and Immunization]-eligible countries are
focusing on infant immunization but this strategy may not be optimal
in all settings. We aimed to collect all available population based
data on pneumococcal meningitis throughout life in the African
meningitis belt and then to model overall meningitis risk to help
inform vaccine policy.

Methods: After a systematic review of literature published from 1970
through the present, we found robust population-based _Streptococcus
pneumoniae_ (Sp) meningitis data across age strata for 4 African
meningitis belt countries that included 35 surveillance years
spanning from 1970 to 2005. Using these data we modeled disease risk
for a hypothetical cohort of 100 000 persons followed throughout life.

Results: Similar to meningococcal meningitis, laboratory-confirmed
pneumococcal meningitis was seasonal, occurring primarily in the dry
season. The mean annual Sp meningitis incidence rates were 98, 7.8 to
14, and 5.8 to 12 per 100 000 among persons <1, 1 through 19, and 20
to 99 years of age, respectively, which (in the absence of major
epidemics) were higher than meningococcal meningitis incidences for
persons less than 1 and over 20 years of age. Mean Sp meningitis case
fatality ratios (CFR) among hospitalized patients ranged from 36-66
percent depending on the age group, with CFR exceeding 60 percent for
all age groups beyond 40 years; depending on the age group, Sp
meningitis mortality incidences were 2- to 12-fold greater than those
for meningococcal meningitis.

The lifetime risks of pneumococcal meningitis disease and death were
0.6 percent (1 in 170) and 0.3 percent (1 in 304), respectively. The
incidences of these outcomes were highest among children age <1 year.
However, the cumulative risk was highest among persons age 5 to 59
years who experienced 59 percent of pneumococcal meningitis outcomes.
After age 5 years and depending on the country, 59-79 percent of
meningitis cases were caused by serotype 1.

Conclusions: In the African meningitis belt, Sp is as important a
cause of meningitis as _Neisseria meningitidis_, particularly among
older children and working age adults. The meningitis belt population
needs an effective serotype 1 containing vaccine and policy
discussions should consider vaccine use outside of early childhood.

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[Numerous cases of meningococcal meningitis are reported in the
sub-Saharan African region known as the "Meningitis Belt" each year
during the hot, dry season, between December and June, and every 8-12
years large outbreaks occur
(<http://wwwn.cdc.gov/travel/yellowBookCh4-Menin.aspx>).

The "Meningitis Belt" extends from Senegal in the west to Ethiopia
and Eritrea in the east
(<http://www.cdc.gov/ncidod/eid/vol9no10/03-0170.htm>). Attack rates
during these cyclic epidemics of meningitis range from 100 to 800 per
100 000 population, but individual communities have reported rates as
high as 1000 per 100 000. [World Health Organization: Meningococcal
meningitis fact sheet.
[<http://www.emro.who.int/sudan/pdf/FactS ... ngitis.pdf>]. While
in endemic disease the highest attack rates are observed in young
children, during epidemics, older children, teenagers and adults are
also affected.

Although epidemics of meningitis are mostly associated with the
meningococcus, there is evidence that increases in pneumococcal
meningitis cases occur in parallel in sub-Saharan Africa during the
hot and dry season [Mar ID, Denis F, Cadoz M. Epidemiologic features
of pneumococcal meningitis in Africa. Clinical and serotypical
aspects (author's transl). Pathol Biol (Paris). 1979; 27(9):543-8;
Leimkugel J, et al. An outbreak of serotype 1 _Streptococcus
pneumoniae_ meningitis in northern Ghana with features that are
characteristic of _Neisseria meningitidis_ meningitis epidemics. _J
Infect Dis 2005, 192:192-199; Yaro S, et al. Epidemiological and
molecular characteristics of a highly lethal pneumococcal meningitis
epidemic in Burkina Faso. _Clin Infect Dis 2006, 43:693-700; and
Antonio M, et al. Seasonality and outbreak of a predominant
_Streptococcus pneumoniae_ serotype 1 clone from The Gambia:
expansion of ST217 hypervirulent clonal complex in West Africa. _BMC
Microbiol 2008, 8:198]

Bacterial meningitis in Africa is associated with high mortality and
risk of neuropsychological sequelae. The 3 leading causes of
bacterial meningitis (_S. pneumoniae_, _Hemophilus influenzae_, and
_N. meningitidis_) are vaccine preventable, and routine use of
conjugate vaccines in African children could provide substantial
health and economic benefits through the prevention of childhood
meningitis cases
(<http://www.who.int/mediacentre/news/sta ... index.html>;
Peltola H. Burden of meningitis and other severe bacterial infections
of children in Africa: implications for prevention. Clin Infect Dis.
2001;32(1):64-75).

The predominant pneumococcal serotype in sub-Saharan Africa has been
found to be serotype 1; this serotype is not included in the
heptavalent pneumococcal conjugate vaccine (PCV) (that contains
serotypes 4, 6B, 9V, 14, 18C, 19F, and 23), but it is included in the
decavalent PCV (that contains serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C,
19F, and 23F).

Maps of the African bacterial meningitis belt can be found at
<http://www.medic8.com/images/map4-9.gif> and
<http://upload.wikimedia.org/wikipedia/c ... ld-Map.png>.
- Mod.ML]

[Alexander]

Preiswerter Impfstoff könnte Afrika vor Meningitis schützen

London - Erstmals könnte eine Impfung Epidemien von Hirnhautentzündung in Afrika verhindern. Damit könnten Ärzte endlich die Oberhand gewinnen im Kampf gegen die gefährliche Erkrankung, die vor allem Kinder trifft. mehr...

Grüsse
Alexander

[Alexander]

Afrika: Massenimpfungen gegen Meningokokken A

In Afrika sollen Anfang Dezember Massenimpfungen mit dem konjugierten Impfstoff MenAfriVac™ gegen Meningokokken A starten. mehr...

Grüsse
Alexander

[Birgitt]

Afrika - Meningokokken-Meningitis
13.12.2010

Während der Trockenzeit (Dezember-April) kommt es in den Ländern des „Afrikanischen Meningitisgürtel“ (Äthiopien, Burkina Faso, Demokratische Republik Kongo, Ghana, Mali, Mauretanien, Niger, Nigeria, Sudan, Tschad, Uganda, Zentralafrikanische Republik) regelmäßig zu Meningokokken-Epidemien. In der Saison 2009 infizierten sich in Afrika fast 90.000 Personen, von denen mehr als 5.000 verstarben. Impfschutz (ACWY) beachten. / Quelle: crm

[Alexander]

Neuer Impfstoff soll Hunderttausende Kinder retten

Ein Impfstoff gegen die Erreger der tödlichsten Form von Lungenentzündung steht jetzt auch für Kinder in ärmeren Ländern zur Verfügung. Der Stoff wurde zum Auftakt einer globalen Impfaktion erstmals in Nicaragua gespritzt. mehr...

Grüsse
Alexander

[Birgitt]

MENINGITIS, POSTINFECTIOUS HYDROCEPHALUS, ACINETOBACTER - UGANDA: (MBALE)
***********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 3 Jan 2011
Source: Eurekalert.org [edited]
<http://www.eurekalert.org/pub_releases/ ... 122210.php>


Hydrocephalus in children [in Uganda] and other developing countries
is seasonal, linked to farm animals and in part, caused by previous
bacterial infection, according to an international team of
researchers from Uganda and the United States, who believe that the
best approach to this problem is prevention.

"Hydrocephalus in infants in developing countries is a grand medical
mystery," said Steven Schiff, the Brush Chair professor of
engineering and director, Penn State Center for Neural Engineering.

Hydrocephalus is a build up of the fluid that normally surrounds the
brain. The increased pressure causes the head to swell and damages
brain tissue. Treatment includes placing a shunt to drain the fluid,
but inevitably these shunts become plugged and require emergency
care, not always available in rural Africa and other resource-limited
regions of the developing world. Surgeons vigorously explore the use
of new brain endoscopes to divert fluid buildup internally in such
children, but this approach addresses the fluid and does not fix
previous infection damage to the brain.

"Brains of children with hydrocephalus can be completely or mostly
destroyed either by the scarring from the disease or by the pressure
of the cerebrospinal fluid that cannot escape," said Schiff. "Many of
these children with the worst aftereffects of infection will be
mentally deficient and survive only as long as their mothers can
adequately care for them. Understanding the causes could eliminate or
prevent the enormous costs to lives and families that hydrocephalus brings."

Hydrocephalus in infants in sub-Saharan Africa is thought to be
caused most often by meningitis-type infections during the 1st month
of life. The U.S. and Ugandan researchers looked at the fluid from
the brains of 3 sets of 25 consecutive infant hydrocephalus patients
during January, July and October [2010] to try to determine the cause
of the disease. By the time parents bring infants with rapidly
growing heads to the CURE Children's Hospital in Mbale, Uganda, the
underlying infection is gone. The researchers were unable to culture
any bacteria from the samples.

To identify traces of previous bacterial infection, the researchers
used DNA sequencing to look for 16S ribosomal DNA that exists in all
bacteria. They reported their findings in the current issue of the
Journal of Neurosurgery: Pediatrics [Lingling L, et al. Association
of bacteria with hydrocephalus in Ugandan infants. J Neurosurg
Pediatrics 2011; 70:73-87. Available at:
<http://www.esm.psu.edu/wiki/_media/rese ... s_2011.pdf>],
showing that 94 percent of the samples contained bacterial remnants.
The researchers found a seasonal difference between samples
representing infection during the dry season that were predominantly
Betaproteobacteria and [infection during the rainy season that were
predominantly Gammaproteobacteria]. [Betaproteobacteria is a class of
Gram-negative bacteria in the phylum Proteobacteria, which includes
_Burkholderia_ and _Neisseria meningitidis_, and Gammaproteobacteria
is a class of Gram-negative bacteria in the phylum Proteobacteria,
which includes _Pseudomonas_, _Escherichia_, and _Acinetobacter_.]
_Acinetobacter_ appeared in the majority [95 percent according to the
Lingling et al J Neurosurg Pediatrics study] of patients following
rainy season infection. Some sequences that appeared in the DNA
analysis were from unknown bacteria, and in many cases, the bacterial
fragments were not identifiable as to the type of _Acinetobacter_
they represented.

In the United States and other industrialized countries, infant
hydrocephalus is usually due to either a congenital anomaly or, in
low birth weight premature infants, due to brain hemorrhages from
immature blood vessels. At one time, Group B _Streptococcus_ was a
common cause of postinfectious hydrocephalus in infants in
industrialized countries, but now physicians test mothers for the
infection and treat with antibiotics before they give birth, and the
infections are rare. Surprisingly, according to Schiff, in Uganda,
none of the remnant DNA in the infants was from Group B _Streptococcus_.

Looking for the source of the neonatal infections, the researchers
targeted the living environment from infants with evidence of prior
_Acinetobacter_ infection and located patients' homes. What they
found were villages of huts where cow dung was pounded into the hut
floors to keep water and ants out and used in patios around the huts
where vegetation is cleared to protect against snakes. Newborns enter
an environment where they not only live near animals but also are
surrounded by their material.

The researchers sampled both the cow dung floors and excrement from
cattle, goats and chickens. They found similar genetic sequences from
the bacteria retrieved from the infants as in the hut floors and
nearby dung. "It is really hard to keep infants to an adequate
standard of cleanliness in this environment," said Schiff. "The
bacteria we found reflects, I think, a significant environmental
influence." While the researchers have not yet proven that these
bacterial infections are the cause of the devastating hydrocephalus
occurrences, they believe that in part, bacterial infections from
animals are the cause.

Historically, certain East African peoples have applied cow dung to
stem bleeding in umbilical cord stumps, which caused newborn
infections. Although such infections are now rare, the scope of
newborn bacterial infections related to living in close proximity to
domestic animals remains poorly categorized.

"As far as we can tell, these types of environmental newborn
infections are the dominant cause of hydrocephalus on the planet,"
said Schiff. "We may be dealing with bacteria that we can't culture,
viruses or parasites, and we may be dealing with different organisms
in different locations."

The researchers are continuing their work and forming an African
Hydrocephalus Consortium with Rwanda, Kenya, Tanzania and Zambia.
They are conducting follow-up clinical trials at the Mbarara
University of Science and Technology in southwest Uganda on
mother-infant pairs with new neonatal infections, and at the CURE
Children's Hospital of Uganda on older infants with postinfectious
hydrocephalus. These trials use next-generation technologies and high
quality microbiology to sort out the causative agents affecting these
infants. They are also continuing to explore the environmental
connection so that public health strategies toward preventing the
initial infections might be found.

[Byline: A'ndrea Elyse Messer]

--
Communicated by:
Thomas James Allen
<tjallen@pipeline.com>

[Hydrocephalus, which is an abnormal accumulation of cerebrospinal
fluid (CSF) in the brain, is a recognized post-infectious
complication in survivors of neonatal meningitis. The investigators
cited in the news release above (Lingling L, et al. Association of
bacteria with hydrocephalus in Ugandan infants. J Neurosurg
Pediatrics 2011; 70:703--00807. Available at:
<http://www.esm.psu.edu/wiki/_media/rese ... s_2011.pdf>)
found most commonly _Acinetobacter_ and _Burkholderia_ DNA by PCR
(polymerase chain reaction) amplification in CSF samples obtained
from Ugandan infants. The children were under one year of age with no
history of hydrocephalus at birth and with either a history of
febrile illness and/or seizures preceding the onset of hydrocephalus,
or endoscopic or imaging findings indicative of prior ventriculitis.

Although post-neurosurgical nosocomial _Acinetobacter_ meningitis is
a known problem (<http://www.jstor.org/pss/4457446>), widespread
community-acquired _Acinetobacter_ meningitis in infants is not a
common problem in developed countries. However, Lingling et al cite
WHO data on _Acinetobacter_ meningitis in community-acquired
meningitis occurring in infants in developing countries.
Nevertheless, they acknowledge that _Burkholderia_ species have been
thought to be a very rare cause of community-acquired meningitis.

Lingling et al state that their cases in Uganda originated south of
the seasonal African meningococcal meningitis belt, and they found no
bacterial DNA consistent with the prior presence of the usually more
common meningitis pathogen _Neisseria meningitidis_ in any of the
samples and rarely encountered that of streptococcal meningitis
pathogens (e.g., Group B streptococcus or _Streptococcus pneumoniae_).

These data raise the issue of possible contamination when trying to
interpret the finding of bacterial DNA in CSF in the absence of
viable organisms. PCR amplifies a single or a few copies of a piece
of DNA, generating thousands to millions of copies of a particular
DNA sequence and, therefore, is especially vulnerable to
contamination. In addition, _Acinetobacter_
(<http://epinews.com/Newswire/2010/06/11/ ... ves-gowns/>)
and _Burkholderia_
(<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm53d827a1.htm>) are
common contaminants frequently found in moist environments. Lingling
et al say they made efforts to avoid contamination with ubiquitous
environmental microorganisms, and genetic analyses indicated
sufficient diversity among the _Acinetobacter_ sequences_ recovered
to suggest that they did arise from a common origin. Nevertheless,
confirmatory data is needed. As Lingling et al point out in their
paper, microbiological studies that attempt to recover viable
microorganisms from CSF in neonatal sepsis and meningitis in Ugandan
infants need to be performed to further address these issues.

Mbale, a city in southeastern Uganda where the CURE Children's
Hospital is located, is approximately 245 km (152 miles) northeast of
Kampala (<http://en.wikipedia.org/wiki/Mbale>). A map of Uganda
showing the Mbale district can be found at
<http://www.reliefweb.int/rw/fullmaps_af ... penElement>.
A map of the African bacterial meningitis belt can be found at
<http://wwwnc.cdc.gov/travel/images/380.ashx>. The
HealthMap/ProMED-mail interactive map of Uganda is available at
<http://healthmap.org/r/01ex>. - Mod.ML]