Epidemiological and molecular characteristics of a highly lethal pneumococcal meningitis epidemic in Burkina Faso
Epidemiological and molecular characteristics of a highly lethal pneumococcal meningitis epidemic in Burkina Faso
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DOI：
10.1086/506940
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发表时间：
2006-09-15
影响因子：
11.8
通讯作者：
Gessner, Bradford D.
中科院分区：
文献类型：
--
作者：
Yaro, Seydou;Lourd, Mathilde;Gessner, Bradford D.
背景资料。撒哈拉以南非洲地区脑膜炎流行的公共卫生和临床策略通常假定脑膜炎奈瑟菌感染是导致大多数疾病的原因。在2002年至2005年的24个月期间，我们收集了布基纳法索3个区疑似急性细菌性脑膜炎病例的临床和实验室信息。肺炎链球菌通过培养、聚合酶链式反应或脑脊液中的抗原检测进行鉴定。采用多位点变数串联重复分型和多位点序列分型方法对肺炎链球菌进行基因分型。从1686人中采集了脑脊液样本；249人(15%)被确认为肺炎链球菌(年发病率为每10万人14例)。在这些患者中，115人(46%)死亡，使肺炎链球菌成为最常见的被识别的微生物，并导致细菌性脑膜炎死亡的三分之二。在脑膜炎流行季节，平均每月发现38例肺炎链球菌感染病例，而其他月份的平均病例为8.7例。在接受检测的48株肺炎球菌中，21株(44%)被鉴定为1型，其余27株(56%)被鉴定为15个不同的血清群和/或血清型。血清1型和其他血清组和/或血清型都是季节性的。在研究期间，1型血清分离株的基因型别与加纳以前发现的主要基因型别相似，但并不完全相同。布基纳法索(以及其他地方)流行季节期间的干预战略现在必须考虑到肺炎球菌脑膜炎的流行模式类似于脑膜炎双球菌脑膜炎。虽然通常分离出一个1型克隆，但超过一半的病例是由其他血清组和/或血清型引起的，基因多样性在相对较短的时期内增加。
Background. Public health and clinical strategies for meningitis epidemics in sub-Saharan Africa usually assume that Neisseria meningitidis infection causes most disease.Methods. During 24 months from 2002 to 2005, we collected clinical and laboratory information for suspected acute bacterial meningitis cases from 3 districts in Burkina Faso. Streptococcus pneumoniae was identified by culture, polymerase chain reaction, or antigen detection in cerebrospinal fluid. Pneumococcal genotyping was performed on strains using multilocus variable-number tandem repeat typing and multilocus sequence typing.Results. Samples of cerebrospinal fluid were collected from 1686 persons; 249 ( 15%) had S. pneumoniae identified ( annual incidence, 14 cases per 100,000 persons). Of these patients, 115 ( 46%) died, making S. pneumoniae the most commonly identified organism and responsible for two-thirds of deaths due to bacterial meningitis. During the meningitis epidemic season, an average of 38 cases of S. pneumoniae infection were identified each month, compared with an average of 8.7 cases during other months. Of 48 pneumococci that were tested, 21 ( 44%) were identified as serotype 1, and the remaining 27 ( 56%) were identified as 15 different serogroups and/or serotypes. Both serotype 1 and other serogroups and/or serotypes were seasonal. The genotypes of serotype 1 isolates were closely related but diversified over the study period and were similar to, but not identical to, the predominant genotypes found previously in Ghana.Conclusions. Intervention strategies during the epidemic season in Burkina Faso ( and perhaps elsewhere) must now account for pneumococcal meningitis occurring in an epidemic pattern similar to meningococcal meningitis. Although a serotype 1 clone was commonly isolated, over half of the cases were caused by other serogroups and/or serotypes, and genetic diversification increased over a relatively short period.