Profile of Neuromeningeal Conditions in a Tropical Setting among Patients Admitted to the Department of Infectious and Tropical Diseases at CHNU De Fann Dakar: A Study of 930 Cases

Introduction: Neuromeningeal disorders comprise a group of severe infectious and non-infectious pathologies, common and clinically diverse, that affect the central nervous system, primarily including meningitis, encephalitis, and suppurative infections. They are common and diverse, and for the most part, remain a public health concern worldwide and especially in Africa. Objectives: To assess the prevalence of neuromeningeal disorders among patients hospitalized in the Infectious and Tropical Diseases Department (SMIT) at CHNU de Fann, and to describe their epidemiological, clinical, paraclinical, and prognostic characteristics. Patients and Methods: This was a retrospective and descriptive cohort study conducted over five years, from January 1, 2018, to December 31, 2022. It included patients presenting with neuromeningeal disorders. Results: Of the 3567 hospitalized patients, 930 were admitted primarily for neurological symptoms, representing a prevalence of 26.07%. There was a clear male predominance (61.29%), with a sex ratio of 1.58. The mean age of the study population was 40 years [5 - 99 years]. Half (50.16%) of the patients came from suburban areas. The informal sector accounted for more than one third of reported cases (37.63%). Married individuals constituted the majority of our study population at 40%. The most frequently observed comorbidities were HIV (25.37%), hypertension (12.68%), diabetes (6.23%), and substance abuse (14%). The most frequent reason for hospitalization was febrile disturbances of consciousness (17.3%). Clinically, the most common signs were headache (61.93%), altered consciousness (69.35%), neck stiffness (40.53%), vomiting (40.10%), motor deficit (29.89%), Kernig’s sign (26.12%), and Brudzinski’s sign (21.07%). The main etiologies were severe malaria in its neurological form (23.11%), neuromeningeal tuberculosis (17.84%), and bacterial meningoencephalitis (14.83%). The mean length of hospital stay was 11 days, ranging from a few hours to 100 days. Outcomes were favorable in 62.8% of cases and stationary in 5.80%. The overall case fatality rate was 31.4%. Conclusion: Neuromeningeal diseases are complex but can be effectively managed with prompt and appropriate intervention. However, it is essential to ensure the prevention of neuromeningeal opportunistic infections during HIV infection, as these typically carry a poor prognosis. Management of these conditions requires a multidisciplinary and collaborative approach.