V.3) CLINICAL PRESENTATION OF PATIENTS
The presentations in our study were divided into two; symptoms
and signs. The most predominant symptom presented in children with bacterial
meningitis was fever at 95.3%, and is similar to that of Nguefack et al who had
fever as the main symptom at 98.8 % at YGOPH [3]. This result
is similar to that of Almuneef et al who had fever as the main symptom at 86 %
[59]. This result is also the same as the one from Heydari who
had fever as the most common symptom at 94.44 % [48]. The high
appearance of fever may be explained by the fact that most infectious diseases
start manifesting with high temperature before any other symptom, and the
knowledge on the fatality of fever on children prompts consultation with this
earliest sign. Zewdie in Ethiopia instead had feeding intolerance at 76.6 % as
the main symptom in neonates [5].Diarrhea was present in our
study at 23.3 % as a digestive manifestation which is rare in meningitis, but
in this setting the bacterium causing gastro enteritis is very common and could
easily find its way into the central nervous system through hematogenous
route.
The most present sign was neck stiffness with 20.9 % which is
contrary to that of Heydari who had fever as the main sign at 94.44 %
[48]. The result is also contradictory to that of Johnson who
had drowsiness/coma at 50.0 % as the predominant clinical sign
[10].
49
V.4) PARACLINICAL INVESTIGATIONS
The biochemical and hematologic analyses of cerebrospinal
fluid in our study are suggestive of bacterial meningitis, with the WBC mean of
1181.2 which is similar to the results gotten from Heydari who had high WBC
count [48]. This mean result of WBC could be explained by the
fact that most of the patients received antibiotic treatments before the lumbar
puncture was performed.
The proteins found in our study were high that is,=1 g/L
predominantly at 30.2 % which is similar to Heydari that had >0.4g/L at
47.2% [48], confirming the presence of bacterial meningitis
,where it is known that proteins tend to increase.
The glucose of <0.4g/L was most present at 20.9 % in our
study and is similar to that obtained with Heydari who had the same quantity at
a higher percentage of 75%, proving the diagnosis of bacterial meningitis
[48].
From our study Streptococcus pneumoniae was the
pathogen mostly found at 63 %, followed by Neisseria meningitidis at
25.0%. These results are contradictory with that of Nguefack et al at YGOPH in
2014 that had Haemophilus influenzae as the predominant pathogen at
39.2 %, followed by Streptococcus pneumoniae at 31.6 % [3].
Nevertheless, our results are similar to that of Fonkoua et al who had
Streptococcus pneumoniae at centre Pasteur in Yaoundé at 56 %
[68]. There is also a similarity with that of Mullan et al in
Botswana that found Streptococcus pneumoniae predominantly with n
=125[66].Touré et al in Bouaké had the same
results as ours with Streptococcus pneumoniae at 48.4 % as predominant
followed by Neisseria meningitidis 16.1 %[8].Otero in
Columbia also had Streptococcus pneumoniae as the predominant pathogen
with a percentage of 11.4 %[72].These discrepancies in results
are justified by the fact that each setting in which the study was done had a
well-planned vaccination programme , which is probably implemented correctly
especially for the Hib vaccine which is proven to be efficient.
The age group of 3 months to 12 months has the highest
percentage of bacterial meningitis caused by Streptococcus pneumoniae
at 35.7 %. This is different to that of Nguefack et al at YGOPH who had
most patients from 2 months - 1 year affected with Haemophilus influenzae
n= 43[3].Touré et al had S. pneumonia
predominance in a higher age group that is 13 - 60 months in
Bouaké[8].These results could be explained
50
by the fact that vaccination completeness in YGOPH was high
for the vaccines at 97.1%[73]explaining the absence of
Haemophilus influenzae in our study , with the introduction of the
Haemophilus vaccine into the PEV in 2009 and the pneumococcal vaccin in 2010 ,
in Cameroon[73].
| 
