The etiology of acute meningitis and encephalitis syndromes in a sentinel pediatric hospital, Shenzhen, China

Hongwei Shen,Xiaorong Liu,Zuer Wang,Wen Ma,Yongxuan Ou,Chunqing Zhu,Chunli Song,Xuejun Ma,Lintao Zhou,Dongli Ma,Yiwen Zhou,Xianghui Shi

doi:10.1186/s12879-019-4162-5

Abstract

BackgroundAcute meningitis and encephalitis syndromes (AMES) is a severe neurological infection which causes high case fatality and severe sequelae in children. To determine the etiology of childhood AMES in Shenzhen, a hospital-based study was undertaken.MethodsA total of 240 cerebrospinal fluid (CSF) samples from 171 children meeting the case definition were included and screened for 12 common causative organisms. The clinical data and conventional testing results were collected and analyzed. Whole genome sequencing was performed on a Neisseria meningitidis isolate.ResultsA pathogen was found in 85 (49.7%) cases; Group B Streptococcus (GBS) was detected in 17 cases, Escherichia coli in 15, Streptococcus pneumoniae in 14, enterovirus (EV) in 13, herpes simplex virus (HSV) in 3, N. meningitidis in 1, Haemophilus influenzae in 1, and others in 23. Notably, HSV was found after 43 days of treatment. Twelve GBS and 6 E. coli meningitis were found in neonates aged less than 1 month; 13 pneumococcal meningitis in children aged > 3 months; and 12 EV infections in children aged > 1 year old. The multilocus sequence typing of serogroup B N. meningitidis isolate was ST-3200/CC4821. High resistance rate to tetracycline (75%), penicillin (75%), and trimethoprim/sulfamethoxazole (75%) was found in 4 of S. pneumoniae isolates; clindamycin (100%) and tetracycline (100%) in 9 of GBS; and ampicillin (75%) and trimethoprim/sulfamethoxazole (67%) in 12 of E. coli.ConclusionsThe prevalence of N. meningitidis and JEV was very low and the cases of childhood AMES were mainly caused by other pathogens. GBS and E. coli were the main causative organisms in neonates, while S. pneumoniae and EV were mainly found in older children. HSV could be persistently found in the CSF samples despite of the treatment. A better prevention strategy for GBS, the introduction of pneumococcal vaccine, and incorporation of PCR methods were recommended.

Highlights

Acute meningitis and encephalitis syndromes (AMES) is a severe neurological infection which causes high case fatality and severe sequelae in children
The prevalence of N. meningitidis and Japanese encephalitis virus (JEV) was very low and the cases of childhood AMES were mainly caused by other pathogens
Group B Streptococcus (GBS) and E. coli were the main causative organisms in neonates, while S. pneumoniae and EV were mainly found in older children

Summary

Introduction

Acute meningitis and encephalitis syndromes (AMES) is a severe neurological infection which causes high case fatality and severe sequelae in children. Acute meningitis and encephalitis syndromes (AMES) is a severe neurological infection which causes high case fatality and severe sequelae including hearing loss and. A broad range of organisms are responsible for bacterial meningitis, including Streptococcus pneumoniae, Haemophilus influenzae, Group B Streptococcus (GBS), Neisseria meningitidis, and Listeria monocytogenes [2]. Other causative organisms such as herpes simplex virus (HSV), enterovirus (EV), and Varicella zoster virus (VZV) are associated with aseptic meningitis and encephalitis [4].

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