The aetiology of purulent meningitis in highland children: a bacteriological study.

Of 155 highlands children with purulent culture-positive meningitis studied from March 1980 to September 1984, 84% were aged twelve months or less and 92% were infected with either Haemophilus influenzae, Streptococcus pneumoniae or both organisms. Other pathogens were Neisseria meningitidis (8 isolations), Streptococcus pyogenes (2 isolations) and Streptococcus agalactiae and Klebsiella species (1 of each). Among H. influenzae isolates, serotype b strains predominated (83%) and most (96%) belonged to biotype I or II. Infections due to non-b haemophili included serotype a (9 strains), serotype f (1 strain) and non-serotypable variants (3 strains). Of 67 S. pneumoniae strains 22% were resistant to benzylpenicillin, with minimal inhibitory concentrations of 0.1-1.0 micrograms/ml. The commonest serotypes were types 5 (11 isolates), type 7 (9 isolates) and types 2, 6 and 46 (6 of each). No resistance to chloramphenicol was detected in either H. influenzae or S. pneumoniae and only one of 56 strains of H. influenzae was insensitive to betalactam antibiotics. The known case fatality rate in this study was 37%. More children with pneumococcal infection died (46%) than those with haemophilus infection (30%), though the difference was not statistically significant; 79% of all deaths occurred in children aged less than twelve months. There is an urgent need for H. influenzae and S. pneumoniae vaccines that are effective in young children.