EPIDEMIC MENINGOCOCCAL MENINGITIS IN ADULT ETHIOPIANS IN ADDIS-ABABA, ETHIOPIA, 1988

278 patients with pyogenic meningitis admitted to the Tikur Anbessa Teaching Hospital in Addis Abeba, Ethiopia, between January and December 1988 were studied prospectively to describe the epidemiology, microbiology, clinical features and outcome of infection. Fifty-nine per cent of the patients were admitted in the hot dry season between January and the end of June. About half of the patients (57%) were in the age group 15 to 19 years; tha male to female ratio was 1.8:1. Two hundred sixty-two specimens (94%) were examined by Gram stain/or culture. N. Meningitidis was cultured from 161 of 243 CSF specimens (65%) and the Gram stain was diagnostic in 108 of 140 CSF specimens (77%). Both Gram stain and culture were negative in 90 of 262 specimens (34%). Thirty-five of the isolates were serogrouped and all were found to belong to serogroup A. All 30 isolates tested for drug sensitivity were resistant to sulfadiazine but sensitive to penicillin. Forty-three of 204 patients died of their infection, a case fatality rate of 21%: 60% of the deaths occurred in the first 24 hours after admission. Eleven of 13 patients with meningococcaemia expired. The case fatality rates for meningitis and meningococcaemia were 16% and 85% respectively. Nine patients (4%) developed neurologic sequalae: 4 hemiplegia, 3 nerve deafness, 2 cranial nerve palsies. This high morbidity and mortality from meningococcal infection demonstrates the need for a national surveillance programme for the prevention and control of meningococcal disease in the country.