TY - JOUR
T1 - Meningococcal meningitis among Rwandan refugees
T2 - Diagnosis, management, and outcome in a field hospital
AU - Heyman, Samuel N.
AU - Ginosar, Yehuda
AU - Niel, Luc
AU - Amir, Jacob
AU - Marx, Nila
AU - Shapiro, Mervyn
AU - Maayan, Shlomo
PY - 1998
Y1 - 1998
N2 - Objective: To study the diagnostic process, clinical course, and outcome of Rwandan refugees with meningococcal meningitis, treated in an Israeli field hospital in Goma, Zaire, in the summer of 1994. Methods: Patient hospital charts and laboratory records were reviewed with critical evaluation of clinical presentation and diagnostic tests. Patients were treated as part of a disaster relief effort in a refugee camp experiencing several coexisting lethal epidemics. Results: A total of 65 patients were identified as having group A meningococcal meningitis. Latex agglutination test for Neisseria meningitidis soluble antigen in the cerebrospinal fluid was found to be a superior diagnostic tool, as compared to Gram stain, and at least as effective as culture. The mortality rate was 14%; mortality was markedly affected by co-morbidity (e.g., dysentery, pneumonia, and malnutrition). Conclusions: The outcome of patients with meningococcal meningitis, treated in referral centers within a disaster area may be favorable, despite overwhelming coexisting epidemics, and may be comparable to that achieved in advanced medical facilities. Encephalopathy may be a diagnostic pitfall in the perspective of coexisting epidemics, requiring a high index of suspicion and routine lumbar puncture. The latex agglutination test is highly useful in achieving prompt diagnosis of meningococcal meningitis, in particular when sample handling for culture and microscopy is suboptimal.
AB - Objective: To study the diagnostic process, clinical course, and outcome of Rwandan refugees with meningococcal meningitis, treated in an Israeli field hospital in Goma, Zaire, in the summer of 1994. Methods: Patient hospital charts and laboratory records were reviewed with critical evaluation of clinical presentation and diagnostic tests. Patients were treated as part of a disaster relief effort in a refugee camp experiencing several coexisting lethal epidemics. Results: A total of 65 patients were identified as having group A meningococcal meningitis. Latex agglutination test for Neisseria meningitidis soluble antigen in the cerebrospinal fluid was found to be a superior diagnostic tool, as compared to Gram stain, and at least as effective as culture. The mortality rate was 14%; mortality was markedly affected by co-morbidity (e.g., dysentery, pneumonia, and malnutrition). Conclusions: The outcome of patients with meningococcal meningitis, treated in referral centers within a disaster area may be favorable, despite overwhelming coexisting epidemics, and may be comparable to that achieved in advanced medical facilities. Encephalopathy may be a diagnostic pitfall in the perspective of coexisting epidemics, requiring a high index of suspicion and routine lumbar puncture. The latex agglutination test is highly useful in achieving prompt diagnosis of meningococcal meningitis, in particular when sample handling for culture and microscopy is suboptimal.
KW - Agglutination
KW - Bacterial meningitis
KW - Diagnosis
KW - Disaster
KW - Epidemic
KW - Meningitis
KW - Neisseda meningitidis
KW - Rwanda
KW - Soluble antigen
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=0031948506&partnerID=8YFLogxK
U2 - 10.1016/S1201-9712(98)90115-1
DO - 10.1016/S1201-9712(98)90115-1
M3 - Article
C2 - 9531659
AN - SCOPUS:0031948506
SN - 1201-9712
VL - 2
SP - 137
EP - 142
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
IS - 3
ER -