Bacterial infections of the central nervous system (CNS) in the newborn are common and are of major clinical importance. By far the most frequent of these infections is neonatal bacterial meningitis. Other bacterial processes include primary intracranial infections (e.g., epidural and subdural empyema and brain abscess) and disorders in which involvement of the CNS is secondary to extraneural infection (e.g., neonatal tetanus). Systemic candidiasis, a disseminated fungal infection, is also part of this chapter. The emphasis will be on the neuropathological, clinical, and neuroimaging features.

Bacterial and Fungal Intracranial Infections

Botulism and tetanus

Background: Neonatal tetanus (NNT), a deadly vaccine preventable disease and one of the most underreported diseases in the developing countries, is seen in the newborn within the first 28 days of life. NNT remains one of the leading causes of deaths among neonates in the developing countries with about 130,000 neonatal deaths recorded in 2004. In the 1989 World Health Assembly and the 1990 world summit for children, WHO/UNICEF together with partner agencies called for the elimination of tetanus by 1995. Despite the global success recorded in the NNT elimination strategy, Nigeria is still among the 25 remaining countries that are yet to achieve the global NNT elimination target as set by the WHO. Study Design: Retrospective study Methods: This quantitative cross-sectional study involved mothers who gave birth to NNT babies between January 2008 and December 2013. . The study used secondary dataset collected by trained NNT surveillance officers in the northeast zone of Nigeria using a standard tool. Results: Although the trend of NNT in the region showed a decrease in cases with fewer cases 9% (27/306) recorded in 2013, the prevalence rate of NNT was unacceptably high at 28.815%. Conclusion: Though at a slow pace, it is clear that the measures put in place by the Nigerian government towards meeting the 2015 NNT elimination deadline is yielding positive results. In spite this, there is need for policy makers to increase their commitments to ensure that Nigeria meet up with the 2015 NNT elimination deadline.

/pdf/prevalence-of-neonatal-tetanus-in-northeastern-nigeria-2r2i15iupw.pdf

Prevalence of Neonatal Tetanus in Northeastern Nigeria

Background: Neonatal tetanus (NNT) is a deadly vaccine preventable disease and one of the most underreported diseases in the developing countries seen in the newborn within the first 28 days of life. NNT remains one of the leading causes of deaths among neonates in the developing countries with about 130,000 neonatal deaths recorded in 2004. Despite the global success recorded in the NNT elimination strategy, Nigeria remains among the 25 remaining countries that record NNT cases. Study Design: Retrospective study Methods: This quantitative cross-sectional study involved mothers who gave birth to children with NNT within their first 28 days of life. The study used secondary data collected between January 2008 and December 2013 from northeast region of Nigeria. Results: The results revealed that 58% had male children (n =182) and the remaining 42% had female children (n = 130). The predominance of the male neonates could partly be as a result of the socio-cultural preference given to the male child in Nigerian. Conclusion: There is the need for parents to promptly seek urgent medical attention for all suspected NNT cases irrespective of the gender of the child to reduce neonatal mortality rates.

/pdf/neonatal-tetanus-and-gender-disparity-57sonl7u2b.pdf

Neonatal Tetanus and Gender Disparity

Background: Neonatal tetanus is a vaccine preventable disease and is a leading cause of neonatal mortality in developing countries. The effectiveness of immunization and hygienic umbilical cord care practices in the prevention of the disease has been established. Objective: The objective of this study was to audit the scourge of neonatal tetanus in a tertiary health facility in a resource-limited setting. Materials and Methods: The study was a retrospective study. Case notes of neonates admitted with clinical diagnosis of tetanus into the Special Care Baby Unit (SCBU) between January 2009 and December 2010 were retrieved and evaluated to identify socio-demographic and clinical characteristics, mode of acquisition and severity of the disease, presence of co-morbidities, duration of hospital stay and outcome. Results: Most of the mothers had no tetanus immunization (66.7%) and the main social class of the children was class V (45.1%) and IV (41.2%), respectively. Only 29.4% of the mothers attended ante-natal care (ANC) while majority of the patients were delivered at home (94.1%). Half of the neonates presented with the severe form of the disease (51.0%). Sepsis is a prominent co-morbidity (59.2%). Morality was high with case fatality of 66.7%. Conclusion: This high prevalence of neonatal tetanus with high mortality is not only disappointing but unacceptable in the 21 st century. Therefore, all efforts must be re-focused on current preventive strategies while pursuing new areas such as slow-release mono-dose tetanus vaccine and school health programme as well as advocacy on political will for the sustainability of immunization programmes of women of child-bearing age.

A review of neonatal tetanus in University of Maiduguri Teaching Hospital, North-eastern Nigeria.

Although tetanus is a well-recognised, well-described, preventable and eradicable infection, it continues to ravage the lives of children in developing countries, especially among neonates. A cross-sectional review of cases of neonatal tetanus seen in LUTH was carried out retrospectively. Thirty-nine (39) cases were studied, comprising 26 (63.4%) males and 15 (36.6%) females, giving a male: female ratio of 1.6:1. Case fatality rate was 10.3%, thirty-five (89.7%) cases survived, of which nine (23.8%) survived with complications. Clinical factors that influence outcome were: a short interval between onset and presentation (p = 0.03), low tetanus score below 6.0 (p = 0.002), hyperpyrexia (p = 0.0001), heart failure (p = 0.035), cyanosis (p = 0.008) and crepitations (p = 0.003). Although several management factors were associated with mortality, these failed to meet statistical significance (p > 0.05). In this study, clinical factors, including presentation interval, were the principal determinants of outcome. The need for intensification and sustenance of preventive measures, early recognition and presentation, prompt treatment as well as improved care are emphasised. We recommend periodic audit of patient clinical data towards improving quality of care.

Clinical and management factors related to outcome in neonatal tetanus.

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Clinical and management factors related to outcome in neonatal tetanus.