Méningites Bactériennes chez l’Enfant au Service de Pédiatrie du CHU Gabriel Toure

RESUME Introduction. Au Mali des efforts ont ete entrepris dans la prevention contre les meningites bacteriennes par l’etat et les partenaires. Le but de notre travail etait d’evaluer la frequence et le profil bacterien des meningites en milieu hospitalier pediatrique apres l’introduction des vaccins. Materiels et Methodes. Nous avons examine les dossiers des enfants hospitalises âges de 1 mois a 15 ans dans le departement de pediatrie du CHU Gabriel Toure pour meningite bacterienne. Nous avons retenu comme meningite bacterienne tout cas dont la cytologie du LCR a objective au moins 10 leucocyte/mm3 avec ou non presence d’un germe a l’examen direct. Resultats. Nous avons etudie cent dossiers d’enfants hospitalises pour meningite bacterienne sur 9280 admission, soit une frequence de 1,07% .une proportion de 12% n’ont pas ete vaccines contre le pneumocoque et l’Haemophilus influenzae b. Les signes neurologiques ont ete les plus frequents (74,98%) a l’examen physique, domines par la raideur meningee (48 ,24%).Plus de la moitie de l’echantillon (66%) avaient recu une antibiotherapie avant l’admission. Les germes les plus frequents ont ete le pneumocoque (27%), l’Haemophilus influenzae b (9 %) et les salmonelles (2%).La letalite etait de 18%. le pneumocoque a ete le germe le plus letal avec 50% de cas (P=0,80). Conclusion. Malgre l’introduction du vaccin anti pneumococcique dans le programme elargi de vaccination du Mali, le pneumocoque demeure encore le germe le plus frequent et le plus letal ABSTRACT Introduction. In Mali efforts have been made to prevent bacterial meningitis by the State and Partners. The purpose of our work was to evaluate the frequency and bacterial profile of meningitis in a Pediatric Hospital after the introduction of vaccines. Materials and Methods. We reviewed the records of hospitalized children aged 1 month to 15 years in the Pediatric Department of Gabriel Toure Teaching Hospital for bacterial meningitis. We have selected as bacterial meningitis any case whose cytology of CSF showed at least 10 leucocytes/mm3 with or without the presence of a germ on direct examination. Results. We studied 100 cases of children hospitalized for bacterial meningitis on 9280 admissions, with a frequency of 1.07%. A proportion of 12% were not vaccinated against pneumococcus and Haemophilus influenzae b. The neurological signs were the most frequent (74.98%) on physical examination, dominated by cervical stiffness (48,24%). More than half of the sample (66%) had received antibiotic therapy before 'admission. The most common pathogens were Pneumococcus (27%), Haemophilus influenzae b (9%) and Salmonella (2%), and lethality was 18%. Pneumococcus was the most lethal germ with 50% of cases (P = 0.80). Conclusion. Despite the introduction of pneumococcal vaccine in Mali's Expanded Program on Immunization (EPI), Pneumococcus remains the most common and lethal germ.