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Cerebrospinal meningitis: lessons learnt from Africa

2019; Elsevier BV; Volume: 19; Issue: 10 Linguagem: Inglês

10.1016/s1473-3099(19)30479-7

1474-4457

Fabrice Simon, Jean‐Paul Boutin, Jean‐Marie Milleliri, Jean‐Nicolas Tournier,

Escherichia coli research studies

Pere Domingo and colleagues1Domingo P Pomar V Mauri A Barquet N Standing on the shoulders of giants: two centuries of struggle against meningococcal disease.Lancet Infect Dis. 2019; 19: e284-e294Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar reviewed two centuries of struggle against meningococcal disease, from the discovery of the bacterium to current management and preventive measures. We would like to enrich this interesting Review with additional breakthroughs made in Africa from the 1950s to the 1970s, which helped people to face the health disaster of epidemic meningitis in sub-Saharan countries. In the meningitis belt, initially described by Lapeyssonnie,2Lapeyssonnie L Cerebrospinal meningitis in Africa.Bull World Health Organ. 1963; 28 (in French).: 1-114PubMed Google Scholar meningococcal disease was endemoepidemic, with huge seasonal outbreaks in the first months of the year causing up to 1000 cases per 100 000 inhabitants. In remote places with a poor and inconsistent medical supply, mortality was very high, especially in the youngest children, which had a strong effect on society (appendix). To address this issue, an innovative public health approach was developed in the 1960s to treat patients with single-dose sulfamethoxypyridazine, administrated by local caregivers according to well designed protocols.3Lapeyssonnie L Louis J Bonnardot R Lefevre M Ist note concerning the activity of a single dose of sulfamethoxypyridazine by intramuscular route in the treatment of meningococcal cerebrospinal meningitis.Med Trop (Mars). 1961; 21 (in French).: 129-133PubMed Google Scholar After the emergence of resistance to sulfamethoxypyridazine, oily chloramphenicol became the best option, fulfilling pharmacological and bactericidal criteria. Oily chloramphenicol was rapidly shown to be highly efficient in sub-Saharan Africa, saving numerous lives for decades after its WHO recommendation in the late 1970s.4Rey M Ouedraogo L Saliou P Perino L Minute treatment of cerebro-spinal meningitis by unique intra-muscular injection of chloramphenicol (oily suspension).Med Mal Infect. 1976; 6 (in French).: 120-124Crossref Scopus (10) Google Scholar, 5Lewis RF Dorlencourt F Pinel J Long-acting oily chloramphenicol for meningococcal meningitis.Lancet. 1998; 352: 823Summary Full Text Full Text PDF PubMed Scopus (16) Google Scholar This drug was replaced in 2004 by single-dose ceftriaxone, which is as efficient as oily chloramphenicol, cheaper, and widely available.6Nathan N Borel T Djibo A et al.Ceftriaxone as effective as long-acting chloramphenicol in short-course treatment of meningococcal meningitis during epidemics: a randomised non-inferiority study.Lancet. 2005; 366: 308-313Summary Full Text Full Text PDF PubMed Scopus (83) Google Scholar The other major progress in controlling massive epidemics of cerebrospinal meningitis A and C in Africa was the development and industrial production of a bivalent polysaccharide vaccine, and its widespread use starting as early as possible after the epidemic onset. Pragmatic mass trials in Africa and Brazil conducted by Mérieux and others showed the feasibility and efficacy of this vaccine strategy.7Triau R Merieux C Against meningococcus: a new form of vaccination.Bull Acad Natl Med. 1979; 163 (in French).: 277-288PubMed Google Scholar Based on an efficient surveillance and alert system, mass vaccine campaigns and early single-dose treatment remain the most efficient public health tools against meningococcal disease in sub-Saharan Africa. For the Review by Domingo and colleagues1Domingo P Pomar V Mauri A Barquet N Standing on the shoulders of giants: two centuries of struggle against meningococcal disease.Lancet Infect Dis. 2019; 19: e284-e294Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar to be complete, these two Africa-developed advances must be put into the limelight as well as the other advances mentioned. This omission might be due to the frequent scotoma on francophone scientific publications by medical search engines and readers who do not speak French. This language bias has been recently acknowledged in a Comment by Anne Roca and colleagues in The Lancet Global Health.8Roca A Boum Y Wachsmuth I Plaidoyer contre l'exclusion des francophones dans la recherche en santé mondiale.Lancet Glob Health. 2019; 7: e701-e702Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar This online publication has been corrected. The corrected version first appeared at thelancet.com/infection on October 9, 2019 This online publication has been corrected. The corrected version first appeared at thelancet.com/infection on October 9, 2019 We declare no competing interests. Download .pdf (.14 MB) Help with pdf files Supplementary appendix Standing on the shoulders of giants: two centuries of struggle against meningococcal diseaseMeningococcal disease was first clinically characterised by Gaspard Vieusseux in 1805, and its causative agent was identified by Anton Weichselbaum in 1887, who named it Diplococcus intracellularis menigitidis. From the beginning, the disease was dreaded because of its epidemic nature, predilection for previously healthy children and adolescents, and high mortality. In the last decade of the 19th century, the concept of serum therapy for toxin-related bacterial diseases was identified. This concept was applied to meningococcal disease therapy, in an independent way, by Wilhelm Kolle, August von Wasserman, and Georg Jochmann in Germany, and Simon Flexner in the USA, resulting in the first successful approach for the treatment of meningococcal disease. Full-Text PDF Correction to Lancet Infect Dis 2019; 19: 429–38Simon F, Boutin J-P, Milleliri J-M, Tournier J-N. Cerebrospinal meningitis: lessons learnt from Africa. Lancet Infect Dis 2019; 19: 1056—In this Correspondence, the email address of the corresponding author should be [email protected] . This correction has been made to the online version as of Oct 9, 2019. Full-Text PDF