ISGlobal is investigating how to improve meningitis suspicion, screening, and diagnostic accuracy in infants younger than 24 months and with permeable fontanel in hospitals and peripheral health centers in low and middle-income countries (LMICs) through a new grant funded by the Bill & Melinda Gates Foundation.
Meningitis can be life-threatening infectious disease when not promptly diagnosed and treated. Despite all the efforts made in the last 30 years, mainly through vaccine programs, 2.5 million new cases of bacterial meningitis happened in 2019, with 236.000 deaths worldwide, most of them among children from LMICs. Even when it does not prove fatal, this disease can still lead to life-compromising sequelae, such as motor and cognitive impairment, hearing loss, vision loss, the development of epilepsy or limb amputation.
When suspected, the gold-standard method for diagnosing meningitis requires the performance of a lumbar puncture to analyze cerebrospinal fluid. Qualified personnel to perform the technique, and laboratory facilities to analyze the fluid, are very scarce in low- and middle-income countries, particularly in remote rural areas. Consequently, the procedure is rarely performed in these areas and therefore meningitis is rarely diagnosed.
Neosonics is an inexpensive, portable, easy-to-use device the size of a wireless telephone. It uses a novel high-frequency ultrasound-based technology to non-invasively detect, through the fontanel, abnormal cell count in the cerebrospinal fluid, which raises clinical suspicion of meningitis in neonates and young infants, who present the most unspecific clinical presentation of the disease, and are most vulnerable age group to suffer it.
“This device provides an innovative solution for the non-invasive diagnosis of meningitis. This method is faster, less expensive and overcomes many of the limitations of the current standard technique—lumbar puncture—which involves a certain degree of risk and requires a laboratory equipped with specific technology that is often unavailable in LMICs,” commented Quique Bassat, the principal investigator of the Neosonics project and an ICREA Research Professor at ISGlobal. This project will strengthen the common effort that share ISGlobal and Neosonics (Newborn Solutions) in fighting against meningitis.
"If we only have the capacity to perform lumbar punctures in a small percentage of neonates and children from LMICs, we will benefit from knowing which ones to prioritize, and Neosonics could easily provide health workers with that information", insists Sara Ajanovic, Scientific Coordinator of the study.
The accomplishment of the general objective of the study in improving the methodology of suspicion and diagnosis of meningitis in neonates and young infants with a permeable fontanel will imply that there is potential to reduce infant mortality and morbidity secondary to this underrecognized life-threatening infection, while reducing 1) unnecessary invasive procedures for its diagnosis; and 2) the use of broad-spectrum antibiotics and the associated global health problem of growing antimicrobial resistance.
A sub study intended to analyze the usability/feasibility/acceptability of this methodology for diagnosis will be performed to understand the end-user’s perception of the device when utilized for the screening of meningitis.
This project continues the collaboration in place with the HER and HER-CHU-Ibn Sina in Rabat, Morocco and The Manhiça Health Research Center – Fundação Manhiça (CISM), Mozambique with the support of two hospitals in Maputo, Hospital Central de Maputo and Hospital Geral de Mavalane.
Neosonics in Morocco
In 2020, thanks to the Call for Innovation Actions for Development of the Spanish Agency for International Development Cooperation (AECID), the project landed in Morocco with the aim of providing the Moroccan health system with a tool to improve access to health for the entire population, and in particular, the screening and diagnosis of such a serious disease as meningitis in infants. Throughout these two years, training has been carried out for health personnel at the Hôpital d'Enfants in Rabat on the use of the device.