Despite effective antibiotics and vaccines, bacterial meningitis (BM) remains one of the leading causes of morbidity and mortality in young infants worldwide. Scarce data on the aetiology and antibiotic susceptibility are available from Africa. To describe the aetiology of BM in Angolan children <90 days. We conducted a prospective, observational, single-site study from February 2016 to October 2017 in the Paediatric Hospital of Luanda. All cerebrospinal fluid samples (CSF) from infants aged <90 days with suspected BM or neonatal sepsis were assessed. The local laboratory performed microscopy, chemistry, culture, and susceptibility testing. PCR for vaccine-preventable pathogens was performed in Johannesburg, South Africa. Of the 1287 infants, 299 (23%) had confirmed or probable BM. Of the 212 (16%) identified bacteria isolates from CSF, the most common were Klebsiella spp. (30 cases), Streptococcus pneumoniae (29 cases), Streptococcus agalactiae (20 cases), Escherichia coli (17 cases), and Staphylococcus aureus (11 cases). A fifth of pneumococci (3/14; 21%) showed decreased susceptibility to penicillin, whereas methicillin-resistant S. aureus (MRSA) was encountered in 4/11 (36%). Of the gram-negative isolates, 6/45 (13%) were resistant to gentamicin and 20/58 (34%) were resistant to 3rd-generation cephalosporins. Twenty-four percent (33/135) of the BM cases were fatal, but this is likely an underestimation. BM was common among infants <90 days in Luanda. Gram-negative bacteria were predominant and were often resistant to commonly used antibiotics. Continued surveillance of the antibiogram is pivotal to detect potential changes without delay.

Malnutrition may be an important cofactor explaining poor outcome of childhood bacterial meningitis (BM) in developing countries. We examined its effect in Latin American children. The weight-for-age z score was determined for 482 children with BM aged 2 months to 5 years. Normal weight (z score from >−1 to <+1), underweight (z score <−1) and overweight (z score >+1) children were compared on admission, in-hospital and at discharge. Using uni- and multivariate analysis, we sought for associations between malnutrition and 3 different outcomes. The mean z score was −0.41 ± 1.54, with a normal distribution. Overall, 260 (54%) patients were of normal weight, 151 (31%) underweight, and 71 (15%) overweight. Compared with others, underweight patients had on admission a lower Glasgow coma score (P = 0.0006) and cerebrospinal fluid glucose concentration (P = 0.03), and a slower capillary filling time (P = 0.02). Their death rate was higher (P = 0.0004) and they survived with more neurological sequelae (P = 0.04), but a similar frequency of hearing impairment (P > 0.05). The odds for death increased 1.98 times by mild (95% confidence interval [CI], 1.03–3.83; P = 0.04), 2.55 times by moderate (95% CI, 1.05–6.17; P = 0.04), and 5.85 times (95% CI, 2.53–13.50; P < 0.0001) by severe underweight. Overweight was not associated with adverse outcomes (P > 0.05). Children who are underweight at the time of onset of BM have a substantially increased probability of neurological sequelae and death.

We explored the changes of the initially highly upgraded cerebrospinal fluid matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of MMP 1 (TIMP-1) response during recovery of childhood bacterial meningitis and their association with outcome. The sizes of these changes varied substantially, but a steeper decrease in the MMP-9 and an increase of the TIMP-1 concentrations augured a better outcome.

Hearing was evaluated in 244 ears of 124 children in Angola by auditory brainstem response audiometry 3 months after bacterial meningitis. Of all ears, 81% recovered without impairment. Of all children, 74% recovered without impairment, 5% had unilateral and 11% bilateral impairment. Seizures before or during hospital stay and disease severity were the best predictors of ≥80 dB impairment.

Bacterial meningitis (BM) is a severe disease caused by various bacterial pathogens. Toll-like receptors (TLRs) protect humans from invading pathogens. In this study, we determined whether single nucleotide polymorphisms (SNPs) of TLR4 and TLR9 are associated with susceptibility to and outcome of BM in Angolan children. Samples were taken from 241 patients and 265 age-matched ethnic controls. The SNPs TLR4 rs4986790 (896A > G) and TLR9 rs187084 (−1486T > C) were determined by high-resolution melting analysis (HRMA). The frequency of variant genotypes in TLR4 was significantly higher in patients with Haemophilus influenzae meningitis than controls (odds ratio (OR), 2.5; 95% confidence interval (CI), 1.2–5.4; p = 0.021), whereas the frequency of variant genotypes in TLR9 was significantly lower in patients with H. influenzae meningitis than controls (OR, 0.4; 95% CI, 0.2–0.9; p = 0.036). No such differences were found with other causative pathogens, such as Streptococcus pneumoniae and Neisseria meningitidis. At the time of discharge, patients with meningitis caused by Gram-negative bacteria who were carriers of variant TLR4 genotypes had a higher risk of ataxia (OR, 12.91; 95% CI, 1.52–109.80; p = 0.019) and other neurological sequelae (OR, 11.85; 95% CI, 1.07–131.49; p = 0.044) than those with the wild-type TLR4 genotype. Our study suggests an association between H. influenzae meningitis and genetic variation between TLR4 and TLR9 in Angolan children.

Background: Hearing loss from childhood bacterial meningitis is believed to develop early and have little tendency for recovery. We performed serial hearing evaluations in a large number of children with bacterial meningitis in Luanda, Angola to clarify if, and how often, the result changed. Methods: Children with confirmed bacterial meningitis and hearing evaluations on admission, day 7 of treatment and the follow-up visit formed the study group. Hearing was tested by auditory brainstem response audiometry using stimuli of 40 dB, 60 dB and 80 dB. Threshold changes are described between the composite levels of 40/60 dB and 80/>80 dB. Results. In all, 235 ears were tested. While the ≤60 dB and ≥80 dB levels were maintained through all 3 examinations in 54% and 5% of ears, respectively, changes occurred in 41%. Deterioration from the ≤60 dB level to ≥80 dB was found in 10% of the ears transiently and in 7% permanently. Improvement from the ≥80 dB level to ≤60 dB occurred in 22% of the ears. Half of the ears with ≥80 dB impairment at the follow-up visit arrived with this finding; the others lost hearing later. Maintaining the ≤60 dB level throughout was associated with milder disease (P = 0.003), fewer convulsions (P < 0.0001) and older age (P = 0.009). Conclusions: Almost half of the ears showed threshold changes after admission during recovery from bacterial meningitis, most frequently improvement of initially severely impaired hearing, but some normal ears or with moderate impairment became severely impaired.