Clinical and bacteriological spectrum of community-acquired acute bacterial meningitis in adults at a tertiary care hospital in northern India

Abstract

Objective : To evaluate the clinical and bacteriological spectrum of community-acquired acute bacterial meningitis (ABM) in an adult population at Lok Nayak Hospital, New Delhi, a tertiary care hospital in northern India. Materials and Methods: Cerebrospinal fluid (CSF) samples from 120 clinically suspected cases of pyogenic meningitis were processed for cell counts, differential counts, bacterial stain and culture, antibiotic susceptibility test, and bacterial antigen detection by latex agglutination test (LAT) in CSF, serum and urine. Results : CSF LAT was positive in 56/120 cases of ABM. Streptococcus pneumoniae was the predominant pathogen in 41 of these 120 cases i.e. 34.0% of all cases. Neisseria meningitidis accounted for 24 cases i.e. 20% of all cases. Staphylococcus aureus was isolated in one case. Bacterial cultures were positive in 22 (18.3%) cases only. Conclusions: Evidence for presence of microbial activity could be detected in 44.1% cases by LAT, whereas a direct microbiological confirmation could be documented in only 22 cases i.e. 18.3%. Streptococcus pneumoniae remains the major etiological agent of ABM in our study. Penicillin resistance was detected in 50% of cases among the isolates which came positive by culture. Neisseria meningitidis was detected in 24 cases. But since none were cultured, sensitivity patterns could not be correlated. LAT is a convenient and rapid test to support bacterial etiology in ABM. In remote situations, their use in serum or urine needs to be considered after evaluation in longer studies. Further research should focus on the preventable aspects of ABM, especially pneumococcal and meningococcal vaccines, to potentially protect susceptible groups.