Sunlight exposure, consumption of vitamin D-rich foods and vulvovaginal candidiasis in an African population: a prevalence case-control study.

BACKGROUND/OBJECTIVES: To date, only two studies have investigated the relationship between vitamin D (vitD) deficiency and candidiasis in spite of vitD's antimicrobial and immunomodulatory roles. We examined the relationship between sunlight exposure and consumption of vitD-rich foods, markers of vitD status, and vulvovaginal candidiasis (VVC) in an African population to add to the limited evidence and stimulate additional research. SUBJECTS/METHODS: Three hundred cases (females diagnosed as suffering from VVC) and three hundred controls (females diagnosed as suffering from any condition other than VVC) were selected from three health facilities in Cape Coast, Ghana. Sunlight exposure was assessed in a structured questionnaire with a food frequency questionnaire used to ascertain the frequency of consumption of vitD-rich foods. RESULTS: Self-reported low sunlight exposure was associated with 3.38 (95% CI:1.99, 5.74) increased odds of VVC. Low and moderate sunlight exposure estimated by outdoor visits was also associated with increased odds of VVC. In sensitivity analysis restricted to matched sunlight exposure data, low and moderate exposure was associated with 5.78 (95% CI: 2.57, 12.99) and 3.53 (95% CI: 1.85, 6.75) increased odds of VVC. Odds of VVC increased with decreasing levels of consumption of vitD-rich foods (Likelihood-ratio test trend p = 0.1382). In the joint analysis, low and moderate vitD intake was associated with much higher increased odds of VVC. CONCLUSIONS: Our findings should be confirmed in prospective studies and clinical trials to strengthen the evidence base for preventive action and to also inform clinical decision making.

DFT study of the interaction between DOTA chelator and competitive alkali metal ions.

1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetracetic acid (DOTA) is an important chelator for radiolabeling of pharmaceuticals. The ability of alkali metals found in the body to complex with DOTA and compete with radio metal ions can alter the radiolabeling process. Non-covalent interactions between DOTA complexed with alkali metals Li+, Na+, K+ and Rb+, are investigated with density functional theory using B3LYP and ωB97XD functionals. Conformational possibilities of DOTA were explored with a varying number of carboxylic pendant arms of DOTA in close proximity to the ions. It is found that the case in which four arms of DOTA are interacting with ions is more stable than other conformations. The objective of this study is to explore the electronic structure properties upon complexation of alkali metals Li+ Na+, K+ and Rb+ with a DOTA chelator. Interaction energies, relaxation energies, entropies, Gibbs free energies and enthalpies show that the stability of DOTA, complexed with alkali metals decreases down the group of the periodic table. Implicit water solvation affects the complexation of DOTA-ions leading to decreases in the stability of the complexes. NBO analysis through the natural population charges and the second order perturbation theory, revealed a charge transfer between DOTA and alkali metals. Conceptual DFT-based properties such as HOMO/LUMO energies, ΔEHOMO-LUMO and chemical hardness and softness indicated a decrease in the chemical stability of DOTA-alkali metal complexes down the alkali metal series. This study serves as a guide to researchers in the field of organometallic chelators, particularly, radiopharmaceuticals in finding the efficient optimal match between chelators and various metal ions.

Sickle Cell Disease: Reappraisal of the Role of Foetal Haemoglobin Levels in the Frequency of Vaso-Occlusive Crisis.

BACKGROUND: Foetal haemoglobin has been implicated in the modulation of sickle cell crisis. Its level is generally inversely proportional to the severity of sickle cell disease (SCD) for a given sickle cell phenotypes. The main aim of therapy for vaso-occlusive crisis (VOC), which is the hallmark of SCD, is to reduce the chances of sickling through the prevention of polymerization of HbS. One way of preventing this polymerization is by increasing foetal haemoglobin levels. OBJECTIVES: To determine the relationship between HbF levels and the frequency of crisis in SCD patients in Ghana. METHOD: A longitudinal retrospective survey covering a period of 30 months was carried out on adult SCD patients at the Sickle Cell Clinic of the Korle-Bu Teaching Hospital. RESULTS: Eighty-three adults aged 15 to 65 years made up of 40 males and 43 femalea were studied. Analysis of variance (ANOVA) gave significant results in Hb and HbF levels. Higher HbF levels were positively related to less frequent crisis and were significantly high in SCD patients than in controls. HbF effects on the clinical manifestations on SCD were variable. CONCLUSION: Threshold values of HbF play a role in reducing the frequency of vaso-occlusive crisis in SCD patients and this finding contributes to the body of available literature on SCD severity. However our work does not give the apparent threshold level of helpful HBF Level in SCD.

Distance from edge determines fruit-feeding butterfly community diversity in afrotropical forest fragments.

We studied the impact of forest edges on the fruit-feeding butterfly communities of three forest remnants in Ghana, West Africa. Community diversity was assessed using traps baited with fermenting banana. Two 200-m, edge-to-interior transects of five traps each were established in each forest. Sampling spanned 1 yr for a total of 180-210 trap days per site and resulted in 2,634 specimens and 56 species. We found significant support for an effect of forest edge on butterfly diversity. The impact of distance from edge on point estimates of diversity, i.e., total trap captures, weighted species richness, and Simpson's diversity, was unique to each forest. Multivariate analyses, which integrated species composition along with relative abundance and richness, uncovered two broad community types, interior communities (those 100, 150, and 200 m distant from the edge) and exterior communities (edge communities and those 50 m distant), indicating that edge habitat generally extends at least 50 m into the forest. However, effects of edges on community diversity were still detected as far as 100 m into the forest. Three species relatively tolerant of forest degradation emerged as indicators of edge habitat. No species were indicative of core habitat.

Asymptomatic bacteriuria in pregnant women attending Antenatal Clinic at Komfo Anokye Teaching Hospital; Kumasi; Ghana

Objective: Symptomatic bacteriuria is common in pregnant women and if untreated could lead to serious complications. Although asymptomatic bacteriuria could also lead to such complications; this fact is not so well known. This study was to determine the prevalence of asymptomatic bacteri-uria in pregnant women attending antenatal clinic at the Komfo Anokye Teaching Hospital (KATH) Kumasi.Design: A prospective study to screen antenatal attendants for asymptomatic bacteriuria.Setting: The study was undertaken at KATH.Participants: All pregnant women attending ante-natal clinic at KATH; Kumasi between February and April 2003 and who agreed to enter the study were clinically evaluated to exclude signs and symptoms of urinary tract infection (UTI).Methods: Samples of 10-15ml urine were exam-ined for pus cells; bacteria and parasitic ova. The samples were further cultured on cysteine lactose electrolyte deficient agar and colony counts yield-ing bacterial growth of 105/ml or more of pure isolates were deemed significant.Results: Of the 220 pregnant women; 16 had sig-nificant bacteriuria giving a prevalence rate of 7.3. The highest age-specific prevalence was found in the 35-39 year-olds (13) and the lowest in the 15-19 year-olds (0.0). There was no sig-nificant difference in prevalence with increasing parity. The dominant bacteria isolates were E. coli (37) and Staph aureus (31).Conclusion: The prevalence of asymptomatic bac-teriuria in pregnant women at KATH is 7.3. The predominant organisms are E.coli and Staph au-reus; and most isolates are sensitive to nitrofuran-toin; cefuroxime and gentamicin

Evaluation of two novel Ziehl-Neelsen methods for tuberculosis diagnosis.

BACKGROUND: Currently, the diagnosis of tuberculosis (TB) in Ghana relies on direct sputum smear, Ziehl- Neelsen (ZN) staining method. This method has low sensitivity and poses some health risks. The study was to compare the, direct sputum smear, (ZN) staining method against two newer ZN methods; 1% Sodium hypochlorite (NaOCL)-xylene floatation and 1% NaOCL sedimentation methods, to determine the most sensitive and the safest STUDY DESIGN: A prospective descriptive study involving 150 adult patients attending Komfo Anokye Teaching Hospital, Kumasi, Ghana suspected of pulmonary tuberculosis, using the three ZN microscopy methods: direct sputum smear, 1% NaOCL sedimentation, and 1% NaOCL-xylene floatation, for the detection of acid fast bacilli (AFB). Sputum culture on Lowenstein-Jensen (LJ) slopes was used as the gold standard for determining the sensitivity and specificity rates. RESULTS: The sensitivity rates of NaOCL sedimentation, NaOCL-xylene floatation and direct smear methods were 77.2%, 71.8% and 66.3% respectively. The specificity rate was 95.9 % for all three methods. Whereas the difference between the NaOCL sedimentation and the direct smear methods was statistically significant (P= 0.0446), that between the NaOCL-xylene floatation and direct smear was not (P=0.1788). CONCLUSION: In spite of the cost of chemicals, the hypochlorite sedimentation method was found to be the most accurate and the safest.

Prevalence of pathogenic Escherichia coli and parasites in infants with diarrhoea in Kumasi, Ghana.

OBJECTIVES: To determine the relative frequencies and prevalence rates of pathogenic Escherichia coli and intestinal parasites in hospitalised infants (0-5 years) in Kumasi. DESIGN: A prospective descriptive study of screening 162 (83 males and 79 females) infants with diarrhoea and 122(64 males and 58 females) non-diarrhoeal infants controls for pathogens (E. coli and intestinal parasites) by standard microbiological methods. SETTING: Komfo Anokye Teaching Hospital and Maternal and Child Hospital, Kumasi, Ghana. RESULTS: From the 162 in the diarrhoeal group 96(59.6%) pathogens, and from the 122 in the control group, eight (6.6%) pathogens were isolated. Enteropathogenic E. coli (EPEC) was the most frequently detected pathogen, accounting for 24(14.8%) of the findings in the diarrhoeal group, five (4.1%) in the non-diarrhoeal control group. Of the 26 EPEC isolates, there were nine serotypes with the three dominant ones being 0125 (6), 0119 (5), and 026 (15). Other agents isolated included Ascaris lumbricoides 18(11.1%) and two (1.6%), Cryptosporidium 13(8.0%) and one (0.8%) for diarrhoeal and non-diarrhoeal infants respectively. The following were detected only in diarrhoeal stools. Giardia lamblia, six (3.7%); Trichomonas hominis, three (1.9%); Trichuris trichiura one (0.6%) and hookworm, one (0.6%). CONCLUSION: From this study, EPEC and Cryptosporidium may be considered as important diarrhoeagenic pathogens and it is hoped that provision of potable water and good sanitation may decrease diarrhoeas in infants caused by these agents.

Salmonellae carrier status of food vendors in Kumasi, Ghana.

OBJECTIVE: To determine the prevalence of chronic typhoidal salmonellae amongst food vendors in Kumasi Ghana. DESIGN: A prospective study. SETTING: Sitting and itinerant food vendors in Kumasi. METHODS: Screening of 258 (230 females of 28 males) healthy food vendors for Salmonella typhi, and S. paratyphi A, B, and C, using stool culture, the widal test, and standard microbiological identification methods. MAIN OUTCOME MEASURES: Prevalence of chronic typhoidal Salmonellae carriers among food vendors in Kumasi. RESULTS: Typhoidal Salmonellae were isolated from six people, giving a carriage rate of 2.3%. Three of the Salmonellae isolated were S. typhi, and they had significant Widal agglutinin titres of > or = 1/160 and > or = 1/320 for 0 and H antigens, respectively. The other three were non-typhoidal Salmonellae. The three had S. typhi and the other three had titres of 1/80 or less for both 0 and H antigens, respectively. We have discussed the implications of this high carriage rate, and we have suggested the inclusion of screening for Salmonellae of the regular health screening exercise undertaken by food handlers to detect and monitor chronic carriers in the food industry, to help control salmonella diseases in the community. CONCLUSION: From our study, food handlers consitute a significant risk in the spread of enteric fever in Kumasi. We therefore, suggest the inclusion of screening for Salmonellae in the regular obligatory six-monthly examination required of food handlers and to monitor those found to be infected.

High mortality of infant bacteraemia clinically indistinguishable from severe malaria.

BACKGROUND: Early recognition of children at highest risk of dying and the targeting of appropriate drug therapy are vital to the improvement of paediatric care in developing countries. This will rely upon the development of simple clinically-based algorithms and treatment guidelines. AIM: To determine the role of bacteraemia in children presenting with clinical signs and symptoms of severe malaria. DESIGN: Retrospective analysis of blood culture results following prospective data collection. METHODS: We studied 251 children presenting with symptoms and signs of severe malaria to a tertiary referral centre in Ghana. Blood was taken for malaria blood films, bacterial culture and haemograms. RESULTS: On the basis of clinical signs alone, malaria-film-positive (n = 182) and -negative (n = 69) patients were indistinguishable. Some 40% of film-negative patients were bacteraemic, vs. 12% of film-positive patients. Severe malaria and bacteraemia were not positively associated. Film-negative bacteraemic patients had a mortality of 39%, primarily affecting the age group <30 months. DISCUSSION: Infants presenting with symptoms and signs of severe malaria but a negative malaria film require immediate antibiotic treatment.

Pulmonary tuberculosis in Kumasi, Ghana: presentation, drug resistance, molecular epidemiology and outcome of treatment.

To assist implementation of tuberculosis (TB) control measures, knowledge of the disease characteristics in a community is essential. This study in Kumasi, Ghana, correlates the clinical presentation, microbiology, molecular epidemiology and clinical outcome of thirty consecutively diagnosed patients with new smear-positive pulmonary TB. Several important factors that potentially promote disease transmission in the community were identified: patients had prolonged duration of productive cough prior to diagnosis (mean=4.1 months; SD=2.1); the disease was typically advanced at presentation and Ziehl-Neelson sputum smears indicated a high bacterial load (80% graded > AFB++); home accommodation was overcrowded with a mean of 3.3 other persons sleeping in the same room as the patients at night. IS6110 restriction fragment length polymorphism (RFLP) fingerprinting of 25 isolated (23 Mycobacterium tuberculosis and 2 Mycobacterium africanum) from epidemiologically unrelated cases identified 3 identical strains and 3 clusters containing 2, 4 and 8 isolates of > or =80% similarity, suggesting high rates of disease transmission. A high prevalence of primary resistance to isoniazid was found (6 out 26; 23%) but resistance to rifampicin, pyrazinamide, ethambutol, streptomycin and ciprofloxacin was not detected. Smear coversion at 2 months and final outcome of treatment with short courses chemotherapy were independent of isoniazid resistance, but the rate of treatment default was unacceptably high (37%). High rates of disease transmission, primary isoniazid resistance and treatment default all indicate poor TB control. The use of rifampicin-containing short-course chemotherapy in this community must be accompanied by adequate resources and infrastructure to ensure very stringent treatment supervision to improve case-holding and reduce the risk of multi-drug resistance.

Determination of diagnostic Widal titres in Kumasi, Ghana.

Three hundred and seven healthy food handlers and 34 blood-culture positive enteric fever patients were screened for Salmonellae agglutinins using the Widal test. Of the 307 healthy food handlers, only 3 (1.0%) had an anti-O titre of > or = 1/160 and 8 (2.6%) an anti-H titre of > or = 1/320 for Salmonella typhi, but the majority, 214 (69.7%) and 149 (48.5%) had titres of < 1/20 for O and H agglutinins respectively. Similar agglutinin titres were also seen for S. Paratyphi A, B, and C. In the 34 enteric fever patients, for S typhi, based on anti-O titre of > or = 1/160, 25 persons showed a significant titre, a sensitivity of 73.5%, and a specificity of 99.0%. And 21 persons showed a significant titre of > or = 1/320 for anti-H, a sensitivity of 61.8% and a specificity of 97.4%. Based on these findings, titres of > or = 1/160 and > or = 1/320 for anti-0 and anti-H respectively, were considered diagnostic for enteric fever in Kumasi, Ghana.

Malariometric update for the rainforest and savanna of Ashanti region, Ghana.

The epidemiological features of human infection with Plasmodium were studied in a community-based survey of 35 villages in the Ashanti region of Ghana. The overall prevalences of malarial parasitaemia in subjects aged > or = 2 years were 50.72% in forest areas and 49.72% in savanna. Plasmodium falciparum was the predominant species everywhere, followed by P. malariae in the savanna and P. ovale in the forest. The highest prevalence of asexual parasitaemia (of any species) occurred in the youngest age-group (2-9 years). The geometric mean intensities of parasitaemia among the parasitaemic (i.e. the parasite density indices) were 557, 640 and 452 parasites/microliter for P. falciparum, P. ovale and P. malariae, respectively. For each Plasmodium species encountered, the mean intensity of parasitaemia decreased with age. Mixed infections were observed in 24% and 30% of the parasitaemic subjects from the forest and savanna, respectively. Those infected with P. falciparum were more likely to carry P. ovale (odds ratio = 2.02) or P. malariae (odds ratio = 2.63) than those who were not infected with P. falciparum. Mean intensities of the parasitaemias in mixed infections were substantially higher than the sums of those in the corresponding single infections. When comparing villages, parasite density indices were found to be correlated with the prevalences of parasitaemia (r = 0.56).

Effect of subinhibitory concentrations of antimicrobial agents (quinolones and macrolide) on the production of verotoxin by enterohemorrhagic Escherichia coli O157:H7.

In Japan, antimicrobial agent therapy for patients with diarrhea due to enterovirulent organisms including enterohemorrhagic Escherichia coli (EHEC) is common, and norfloxacin (NFLX), fosfomycin, and kanamycin are recommended for EHEC treatment by the Japanese Ministry of Health and Welfare. The aim of this study was to analyze the effects of antimicrobial agents which have been used or recommended for the treatment of EHEC on the production of verotoxin (VT) in vitro. Subinhibitory concentrations of quinolones, NFLX, sparofloxacin (SPFX), and grepafloxacin (GPFX) markedly stimulated the productions of VT1 and VT2. The macrolide azithromycin (AZM), erythromycin (EM), and clarithromycin (CAM) did not stimulate the production of VT at a wide range of concentrations. These in vitro results indicate that when quinolones are prescribed for a patient infected with EHEC, the concentration of antimicrobial agents used in vivo and the susceptibility of the EHEC strains against quinolones should be taken into consideration.

Life-threatening cutaneous reactions to thiacetazone-containing antituberculosis treatment in Kumasi, Ghana.

Antituberculosis treatment containing thiacetazone is associated with a high incidence of life-threatening cutaneous drug reactions in patients infected with the human immunodeficiency virus (HIV). In order to develop a local policy concerning the use of this drug, a study was undertaken to determine the incidence of such reactions in a total of 1063 Ghanaian adult patients treated for pulmonary tuberculosis (PTB) with thiacetazone-containing regimens. The incidence was retrospectively determined in 3 different treatment groups, comparing: (A) unselected use of thiacetazone; (B) exclusion of thiacetazone from all patients with positive HIV serology; (C) selective exclusion of thiacetazone from patients with clinical criteria suggesting HIV infection plus education of health workers and patients. Of the 408 patients in group A receiving thiacetazone, 9 (2.2%) developed life-threatening cutaneous reactions and 7 of these were HIV-positive. Overall, 6.8% of HIV-positive patients compared to 0.65% of HIV-negative patients developed severe reactions (P < 0.01; relative risk = 10.5). Six of the 9 patients with reactions died. All 379 patients in group B were screened for HIV antibodies and positive cases (23%) received a regimen in which thiacetazone was substituted by ethambutol. In contrast to Group A, only one HIV-negative patient (0.26%) developed a severe cutaneous reaction (P = 0.02). Among 276 patients in group C, thiacetazone was substituted with ethambutol only in those with clinical evidence of HIV infection (8%) and staff and patients were educated about early recognition of the side-effect. With this policy, these were no admissions with severe cutaneous reactions compared to 2.2% of those in group A (P = 0.01). In conclusion, a policy of selective use of thiacetazone in the treatment of PTB based on clinical criteria combined with patient and staff education was found to be a practical and cost-effective strategy combating severe cutaneous reactions to thiacetazone.

Prevalence and genotype of hepatitis C virus infection in pregnant women and blood donors in Ghana.

The seroprevalence of hepatitis C virus was evaluated in blood donors and antenatal clinic attenders in Kumasi, Ghana and seropositive subjects were tested for hepatitis C virus ribonucleic acid by the polymerase chain reaction (PCR). The overall seroprevalence among Ghanaians was 2.8% but there was a significantly higher prevalence in males (4.6%) than in females (1.0%). No risk factor for infection was identified by a questionnaire. Among those who showed evidence of active infection with a positive PCR, the most common genotype was type 2 but the subtype could not be specifically determined; these type 2 hepatitis C viruses may be indigenous to Africa.

Study of the aetiologic agents of meningitis in Kumasi, Ghana, with special reference to Cryptococcal neoformans.

OBJECTIVE: To evaluate the importance of Cryptococcus neoformans, an opportunistic in meningitis, in healthy and HIV infected patients in Kumasi, Ghana. DESIGN: A prospective study; isolating the aetiologic agents of meningitis from cerebrospinal fluid (CSF) using standard methods. SETTING: Kumasi city, Ashanti region of central Ghana. SUBJECTS: One thousand five hundred and seventy patients suspected of meningitis, including 28 HIV infected and AIDS patients. MAIN OUTCOME MEASURE: The pattern and distribution of the main etiologic agents of meningitis in Kumasi, Ghana shown. RESULTS: Of the 1570 CSF samples examined, 1256 (80%) showed no abnormality. Of the 314 (20%) with abnormalities, 147 were bacterial, and 167 diagnosed aseptic. No cryptococcal cells were found. CONCLUSION: There is a paucity of cryptococcal meningitis in Kumasi, Ghana, and it is not recommended to screen routinely for the fungus in meningitis investigations.

Evaluation of a commercial immunodiagnostic kit incorporating lipoarabinomannan in the serodiagnosis of pulmonary tuberculosis in Ghana.

UNLABELLED: We evaluated 'Mycodot', a commercially marketed immunodiagnostic test for tuberculosis which detects antibodies to lipoarabinomannan antigen. Serum was tested from 52 patients with newly diagnosed smear-positive pulmonary tuberculosis, of whom 20 were HIV-positive and 32 HIV-negative. Control sera were taken from 40 patients of whom 20 had acute non-tuberculous lobar pneumonia and 20 patients had no respiratory disease. The test was found to have a very high specificity of 97.5% (95% CI:92.5-100%). However, the sensitivity in HIV-negative patients was 56% (95% CI:39-73%), and was substantially lower at 25% (95% CI:6-44%) in HIV-positive patients. IN CONCLUSION: 'Mycodot' was found to be a highly specific and easily performed assay. However, the poor sensitivity, especially in HIV-infected patients, renders it unlikely to be useful either as a primary or adjunctive diagnostic test for tuberculosis, particularly in countries with a high prevalence of HIV. A larger trial of this assay in Ghana was not deemed necessary.

Effect of antimicrobial agents, especially fosfomycin, on the production and release of Vero toxin by enterohaemorrhagic Escherichia coli O157:H7.

In 1996, Japan had several large outbreaks of enterohaemorrhagic Escherichia coli (EHEC) O157:H7 infection. We surveyed physicians who examined and treated these patients, and found that most of the patients (95.9%) received antimicrobial agents as treatments, in particular, fosfomycin comprised 84.0% of the prescribed treatment. Since the administration of antimicrobial agents for EHEC infection is under discussion, we also analyzed the effects of 7 antimicrobial agents including fosfomycin on the production and release of Vero toxins (VTs) by EHEC. The addition of fosfomycin into EHEC culture in CAYE broth at 5 h after the start of incubation caused a marked increase of VT1 release and production, as revealed by an immunological toxin assay (RPLA). However, a cytotoxicity assay of Vero cells showed a small increase of biological activity in the specimens treated with fosfomycin because the Vero cell assay reflects total cytotoxicity of VT1 and VT2. These results indicate that further study is necessary before concluding whether antimicrobial agents actually worsen an EHEC infection.

Epidemiology of Buruli ulcer in Amansie West district, Ghana.

This paper describes 90 cases of Buruli ulcer in Amansie West district, Ghana. 49% were below 15 years of age while 20% were over 50 years. There was a significant difference in the age and sex composition, with more males among the younger age groups than females but the converse among adults. Seasonal variation is described, with peak incidence in September and October. Cases who had received bacillus Calmette-Guérin (BCG) vaccination had a shorter duration of the ulcer than those who were not vaccinated. No such association was found between BCG vaccination and the age of onset of the disease. There was no significant difference between cases and controls regarding their BCG vaccination status. There is an urgent need to regard Buruli ulcer in Ghana more seriously.

A study of bacterial meningitis in Kumasi, Ghana.

A prospective study of acute bacterial meningitis in infants and children in Kumasi, Ghana identified 69 cases by culture or antigen detection. Of these, 50.7% (n = 35) were S. pneumoniae, 34.8% (n = 24) N. meningitidis and 14.5% (n = 10) H. influenzae. The mortality for each pathogen was 36.4%, 17.4% and 30%, respectively, showing no significant difference. In pneumococcal meningitis, the most significant clinical factor associated with an increased mortality rate or subsequent neurological sequelae was a lowered level of consciousness at admission (chi 2 = 8.66, d.f. = 1, p = 0.003). Antibiotic susceptibilities were determined in the 40 positive isolates. Six cases of N. meningitidis and two of S. pneumoniae were penicillin-resistant, and there was a single case of chloramphenicol-resistant S. pneumoniae.