Epidemiologic pattern of meningococcal meningitis in northern Cameroon in 2007–2010: contribution of PCR-enhanced surveillance

Abstract

OBJECTIVES: Monitoring acute bacterial meningitis in northern Cameroon. METHODS: Health professionals collected cerebrospinal fluid (CSF) specimens from patients presenting with clinical symptoms of meningitis. Specimens were tested using gram stain, latex agglutination test, and culture. A PCR assay completed the diagnostic testing. Multilocus sequence typing (MLST) was performed on some Neisseria meningitidis (Nm) isolates. RESULTS: From 2007 through 2010, of the 1429 CSF specimens tested, 292 (20·4%) were positive, either for Nm (205), Streptococcus pneumoniae (Sp) (57), or Haemophilus influenzae (Hi) (30). From 2007 through 2009, the serogroup W135 represented 98·8% of 164 case isolates. Until 2008, most serogroup W135 isolates presented the sequence-type ST-2881 usually associated with sporadic cases. Since 2009, the ST-11 (an epidemic-associated clone) became predominant, although no epidemic occurred. Serogroup A ST-7 was observed in 2010 and caused a localized epidemic. Using the detection PCR on turbid CSF, a 2·7-fold increase in cases with etiologic diagnosis was obtained, compared to culture. All tested meningococcal isolates (42) were susceptible to ampicillin, chloramphenicol, and cefotaxim. CONCLUSIONS: Resurgence of serogroup A and recent increase in ST-11 among serogroup W135 isolates were worrying when considered with the epidemic wave of serogroup A meningitis, which affected neighboring countries and the serogroup W135 epidemic in Niger in 2009-2010.