Rapid introduction of oral antivirals for COVID-19: implementation of a test and treat program in four African countries

Introduction: Streptococcus pneumoniae is the most frequent and serious cause of bacterial meningitis, currently accounting for 70% of all cases of community-acquired bacterial meningitis, with a case-fatality rate of 17-30%.The purpose of this study was to describe the epidemiological, clinical, bacteriological, therapeutic and evolutionary aspects of purulent Streptococcus pneumoniae meningoencephalitis in adults in Casablanca.Methods: Descriptive study of 13 adults admitted for purulent Streptococcus pneumoniae meningoencephalitis to the infectious diseases department of Ibn Rochd Hospital Center from January 2021 to December 2023.Results: The median age was 40 (interquartile range [IQR]: 19-56) years with a sex ratio (M/F) of 1.6, and 62% (8/13) of patients were male.The most common sites of onset were head trauma with osteomeningeal breach (54%) and ENT infections (31%), and the underlying factor was diabetes mellitus (15%).The clinical manifestations of all patients were meningeal syndrome, infectious syndrome (fever) and encephalitis syndrome (disturbed consciousness and comitiality).The intracranial complication associated with meningitis, hydrocephalus, occurred in 8.8% of cases.CSF was purulent in 9 cases (69%), and cytochemical examination revealed a predominantly neutrophilic pleocytosis with a median count of 1887 elements/mm 3, hyperproteinorachia (IQR: 14 0.74 g/l) and hypoglycorachia (IQR: 1.87 0.049).Bacteriological confirmation was provided by direct examination of CSF (10 cases, 77%) and multiplex PCR (3 cases, 23%).The sensitivity was 100% for ceftriaxone and vancomycin.Ceftriaxone was used as initial monotherapy, and vancomycin was added if the patient's state of consciousness did not improve.All patients were also treated with dexamethasone-based corticosteroids.The case fatality rate was 46%.Disturbed consciousness was the main risk factor for lethality and antibiotic therapy (ceftriaxone and vancomycin).Discussion: The use of empirical vancomycin did not improve mortality rates.Patients in critical condition [1,2] and of advanced age [1,3] die more frequently.The problems of antibiotic resistance and empirical treatment (ceftriaxone and vancomycin) pose a real challenge to the practitioner.The beneficial effects of dexamethasone corticosteroid therapy in adults with pneumococcal meningitis are currently recognized [4,5].In our case, 46% of patients who died were treated with corticosteroids.Complications of pneumococcal meningitis are dominated by neurological damage, which