Agent Of Bacterial Meningitis Research Articles

The Causative Organisms of Bacterial Meningitis and their Antimicrobial Resistance Profiles in Iranian Children in 2011-2016.

The study aimed to describe the identity and antimicrobial resistance patterns of the causative agents of bacterial meningitis in children referred to Children's Medical Center (CMC) Hospital, Tehran, Iran. This retrospective study was performed at CMC Hospital during a six-year period from 2011 to 2016. The microbiological information of the patients with a diagnosis of bacterial meningitis was collected and the following data were obtained: patients' age, sex, hospital ward, the results of CSF and blood cultures, and antibiotic susceptibility profiles of isolated organisms. A total of 118 patients with bacterial meningitis were admitted to CMC hospital. Sixty-two percent (n=73) of the patients were male. The median age of the patients was ten months (interquartile range [IQR]: 2 months-2 years) and the majority of them (n=92, 80%) were younger than two years of age. The highest number of patients (n=47, 40%) were admitted to the surgery department. Streptococcus epidermidis was the most frequent isolated bacterium (n=27/127, 21%), followed by Klebsiella pneumoniae (n=20/127, 16%), and Staphylococcus aureus (n=16/127, 12.5%). Blood culture was positive in 28% (n=33/118) of patients. Ampicillin-sulbactam and imipenem were the most effective antibiotics against Gram-negative bacteria isolated from CSF cultures. In the case of Gram-positive organisms, ampicillinsulbactam, vancomycin, and linezolid were the best choices. Imipenem was the most active drug against Gram-negative blood pathogens. Also, ampicillin and vancomycin had the best effect on Gram-positive bacteria isolated from blood cultures. Results of this study provide valuable information about the antibiotic resistance profiles of the etiologic agents of childhood meningitis, which can be used for prescription of more effective empirical therapies.

Predictors of Bacterial Meningitis among Paediatric Patients Aged 0 - 5 Years at Kenyatta Hospital, Kenya

Introduction: Meningitis remains a common and serious problem in children worldwide. One million instances of meningitis are assessed to happen in children worldwide each year. In Africa, where outbreaks are common 70% of meningitis cases are diagnosed in children under the age of five (5) years. Though in most cases, doctors diagnose early and adequate treatment started, 5% to 10% of patients still succumb during the 24 - 48 hours after onset of clinical features. In 2009, the mortality rate in Africa was four thousand deaths. Study Objective: This study describes the predictors of bacterial meningitis among children aged 0 - 5 years admitted at Kenyatta National Hospital (K.N.H.) paediatric wards. Methodology: The study adopted a descriptive cross-sectional design. It was carried out in K.N.H. paediatric wards. Data were obtained from consenting parent or guardian and healthcare workers (nurses and registrars). Study participants were selected by convenient sam-pling method. A total of 104 study participants were included in the study sample. In-depth interviews of key informants were conducted on 7 health workers; 5 nurses from the paediatric wards and paediatric emergency unit and 2 paediatric registrars. Ethical consideration included full disclosure to participants, confidentiality, security of health records and informed consent. Data were collected by use of researcher administered semi-structured ques-tionnaire and desk reviews of patients’ files were also used. Qualitative data from the interviews were audio-taped. Logistic regression analysis was used for data analysis. Quantitative data were cleaned, entered and analysed using Statistical Package for Social Sciences (SPSS) version 23. Results were displayed by utilization of tables, pie charts. Qualitative data were transcribed, grouped in themes and analysed manually. Study Results: The majority of the children (55.8%) were female. The highest percentage of the children (53.8%) was aged less than one year. The highest proportion of the parents (39.4%) was within the age group of 26 - 30 years. Neonatal sepsis (37.5%), neonatal jaundice (25.0%) and for observation (25.0%) were the common reasons for admission to NBU. Children admitted and managed in the nursery unit were significantly 2.7 times more likely to have bacterial meningitis compared to those children never admitted to the nursery [OR = 2.75; 95% CI = 1.08 - 7.00; P = 0.031]. Streptococcus pneumonia was the main (51.2%) causative agent of bacterial meningitis among the children. Children who were taken to hospital in delay after illness were 1.740 times more likely to exhibit meningitis than those taken to hospital immediately. Children whose parents had higher levels of income were two times less likely to exhibit meningitis than those with lower. Majority (62.5%) resided in mid urban and slum areas. Most lived in a one (1) bed-roomed house and most houses (60.6%) had more than five people living in it. The main co-existing illnesses among the children were pneumonia (53.8%) and heart disease (22.9%). Conclusions: Streptococcus pneumoniae was the common causative agent of meningitis among the study population. The enviromnetal factors such as living in overcrowded areas, inadequate exposure to health education contributed to contracting and developing meningitis. Financial contraints among caregivers posed a hindrance to the participants in seeking medical attention early. A previous upper respiratory tract infection more often led to contracting meningitis.

Homology Modeling and Structural Validation Studies of 3 Oxoacyl (Acyl Carrier Protein) Synthase II and Dihydropteroate Synthase Protein of Neisseria meningitides

Abstract Objective: Neisseria meningitidis (NM) is foremost causative agent of bacterial meningitis. The two very important protein has been selected for the study of homology modeling and structural validation in Neisseria meningitis. The 3 oxoacyl (acyl carrier protein) synthase II (3OASII) enzyme which involved in fatty acid biosynthesis of Neisseria meningitidis. This enzyme in fatty acid synthesis and target for discovery of novel antibacterial agent. Dihydropteroate synthase (DHPS), an enzyme plays an acute role in the bacterial folate metabolism which catalyzes the development of 7, 8- dihydropteroate from p-aminobenzoic acid (pABA) and 6- hydroxymethyl-7, 8-dihydropterin-pyrophosphate (DHPP). The absence of the folate pathway in higher eukaryotes makes it an attractive drug target. In current study, a complete 3 oxoacyl (acyl carrier protein) synthase II and Dihydropteroate synthase protein structure model was generated using Modeller V9.12 software so as to understand the mechanistic detail of its functioning. The energy minimization analysis using YASARA and the stereo chemical quality of the models was checked by Rampage, Verfy3D, Errat, ProSA and QMEAN servers. The analysis of present studies provide three dimensional (3D) structure of 3 oxoacyl synthase II and dihydropteroate synthase protein will be helpful for the advance study of drug designing in meningitis disease.Conclusions: The current study showed that 3 oxoacyl synthase II and Dihydropteroate synthase modeled protein is highly reliable and stable, so it will use to identifying the drug designing research of meningitis disease.

Bacterial Paediatric Meningitis Laboratory Diagnosis

Introduction: Bacterial meningitis is one of the top ten causes of death amongst children under 5 years in Zimbabwe. Optimizing the identification of the etiologic agents of bacterial meningitis leads to better management of patients. The objective of this study was to compare the effectiveness of latex agglutination (LA), culture and Polymerase Chain Reaction (PCR) as diagnostic methods in the detection of Neisseria meningitidis, Streptococcus pneumoniae, Streptococcus agalactiae and Haemophilus influenzae in paediatric cerebral spinal fluids (CSF) specimens at Harare Children`s Hospital (HCH). Methodology: Specimens from 162 clinically suspected paediatric cases of bacterial meningitis were processed by cell count, Gram stain, culture, latex agglutination and PCR. Results: Forty-nine (30.2%) suspected cases were positive for at least one of the four bacterial organisms. The latex agglutination test was positive in 33/49 (67.3%) cases, PCR was positive in 37/49 (75.5%) and culture was positive for 17/49 (34.7%) cases. Streptococcus pneumoniae was the predominant pathogen detected in 29 of the 49 positive cases (59.2%) followed by S. agalactiae detected in 11/49 (22.4%) cases. Haemophilus influenzae was detected in 7/49 (14.3%) cases while N. meningitidis accounted for 2/49 (4.1%) positive cases. Thirty-three (20.4%) CSF samples tested positive with the latex agglutination test. This increased the number of organisms above that detected by culture by 16/49 (32.6%). Polymerase chain reaction detected 37 CSF samples increasing the number of organisms detected by culture by 20/49 (40.8%). Conclusion: Bacterial meningitis mainly caused by Streptococcus pneumoniae is prevalent among children in Zimbabwe and coupling of culture and non-culture methods can improve detection of the disease.

Türkiye’de Neisseria meningitidis Serogrup X’e Bağlı İlk Menenjit Olgusu

Neisseria meningitidis, an agent of bacterial meningitis, is classified into 13 different serogroups. Serogrups A, B, C, W135 and Y are the predominant serogroups. A meningococcal vaccine containing serogroups A and C has been used to prevent recruits from this fatal disease until May 2009 in Turkey. From then on, administration of the quadrivalent vaccine consisting of

Limited efficacy of pentoxifylline as anti-inflammatory agent in experimental pneumococcal meningitis

SUMMARY Dexamethasone appears to show some adverse side-effects as adjunctive anti-inflammatory agent in bacterial meningitis. For this reason, we tested the anti-inflammatory and neuroprotective effect of pentoxifylline administered 15 min before starting antibiotic treatment with ceftriaxone (n = 10) versus antibiotic therapy alone (n = 9) in the rabbit model of pneumococcal meningitis. Pentoxifylline lowered the medians of leucocyte density, tumour necrosis factor-alpha (TNF-α) and lactate in the cerebrospinal fluid (CSF), but only leucocyte migration into the subarachnoid space was significantly inhibited 8 h after initiation of therapy (P = 0.01). CSF protein, brain water content, and the entry of ceftriaxone into CSF were not influenced by pentoxifylline. The density of neuronal apoptoses in the dentate gyrus was slightly lower in animals receiving pentoxifylline than in those treated with ceftriaxone only. The median concentration of neuron-specific enolase in CSF was lower in the pentoxifylline-treated group, but the difference was not significant. In conclusion, pentoxifylline showed some anti-inflammatory activity in pneumococcal meningitis, but the substance failed significantly to reduce neuronal damage.

Meningococcal meningitis with myelopathy: case report and review of literature

Abstract Neisseria meningitis is a common etiological agent in bacterial meningitis in humans. Common complications associated with meningococcal meningitis include cranial nerve palsies, hydrocephalus, seizures, stroke, cerebritis or brain abscesses. Spinal cord dysfunction is a very rare complication of meningococcal meningitis and its occurrence is limited to case reports only. We report such a case along with a review of available literature and underlying pathogenetic mechanisms. Case report: Our patient diagnosed as a case of meningococcal meningitis developed multiple cranial nerve palsies followed by flaccid paraplegia with bowel bladder involvement during the recovery phase of the disease. Spine MRI showed mild cord edema and diffuse patchy areas of altered intramedullary signal intensity in dorsal cord suggestive of myelitis. The patient was treated with antibiotics and intravenous methyl-prednisolone along with supportive physiotherapy. His neurological deficits showed marked improvement on subsequent follow up.

Serious community-acquired paediatric infections in rural Asia (Bohol Island, Philippines): Bacterial meningitis in children less than 5 years of age

This paper describes the clinical profile and aetiology of bacterial meningitis in infants and children less than 5 y old admitted to a rural general hospital in the Philippines. A total of 989 infants and children 0-59 months old with suspected meningitis using a standardized guideline based on clinical signs and symptoms were prospectively enrolled from April 1994 to May 2000. Blood and CSF were drawn on admission for culture, antigen testing and cell count. All had blood cultures and 623 (63%) had CSF samples. Bacterial aetiology was found in 54 (5%). The most common bacterial pathogens were H. influenzae type b (Hib) (20, 37%) and S. pneumoniae (Pnc) (10, 18%). All of the Hib infections and 8 (80%) Pnc infections were in infants less than 1 y old. 12 (22%) of the subjects with bacterial meningitis died. All strains of S. pneumoniae and H. influenzae were sensitive to chloramphenicol, cotrimoxazole and ampicillin. In conclusion, S. pneumoniae and H. influenzae type b are the most common aetiological agents of bacterial meningitis in a rural area in the Philippines, and occur especially in infants less than 1 y old. Aetiological agents were susceptible to the currently recommended antimicrobial agents.

First Confirmed Case of Vancomycin-Resistant Enterococcus faecium Meningitis in Turkey:

Vancomycin-resistant enterococci are unusual etiologic agents of bacterial meningitis and pose significant therapeutic difficulties. We report the first con-firmed case of nosocomial vancomycin-resistant Enterococcus faecium meningitis in Turkey. The patient was treated with chloramphenicol and cerebrospinal fluid cultures became negative, but clinical success was not achieved. We also review the previously reported cases of vancomycin-resistant Enterococcus faecium meningi-tis.

Incidence and etiological agents of bacterial meningitis among children

To expand upon the limited comprehensive population-based data for childhood bacterial meningitis in Eastern Europe, the present study was conducted in the Iasi and Constanta districts of Romania. From March 2000 through March 2002, children <5 years of age hospitalized for bacterial meningitis were enrolled in a prospective surveillance study. A total of 56 cases of bacterial meningitis were identified, including 37 due to Neisseria meningitidis (22 per 100,000 per year), 13 due to Haemophilus influenzae type b (7.6 per 100,000 per year), and six due to Streptococcus pneumoniae (3.5 per 100,000 per year). Of the 31 meningococcal isolates that were serotyped, 12 were serogroup A, eight were serogroup B, and 11 were serogroup C. Among all cases of bacterial meningitis, 25 occurred in children <1 year of age, including those due to meningococci (n=14), H. influenzae type b (n=7), pneumococci (n=3), and Klebsiella pneumoniae (n=1). In Romania the incidence of H. influenzae type b meningitis is similar to that found in other areas of Southern and Eastern Europe during the pre-vaccination era, and the incidence of meningococcal meningitis is one of the highest yet found in Europe. An unexpectedly high proportion of these meningococcal meningitis cases is due to serogroup A. Disease burden could be substantially reduced through the introduction of H. influenzae type b conjugate vaccine and, when available, meningococcal conjugate vaccine protective against serogroups A, B and C.

Genetic relatedness, antibiotic susceptibility, and serotype distribution of Streptococcus pneumoniae responsible for meningitis in Poland, 1997-2001.

Streptococcus pneumoniae is the third most frequent etiologic agent of bacterial meningitis in Poland. Therefore, the objective of this study was to characterize S. pneumoniae isolates responsible for meningitis in Poland from 1997 to 2001 by determining their serotypes, antimicrobial susceptibility, and genetic relatedness. Among 36 serotypes and rough isolates, the most common were serotypes 3, 8, 19F, 6B, 4, and 23F, altogether accounting for 45.3% of cases. Penicillin-nonsusceptible pneumococci constituted 14.8% of all isolates. A high heterogeneity of pneumococcal isolates concerning serological features as well as genetic relatedness based on pulsed-field gel electrophoresis analysis was observed. With the exception of some serotypes (e.g., 3, 7F, 19F), isolates of the same serotype do not appear to be more closely related to each other than to isolates of different serotypes.

Cryptococcal glucuronoxylomannan delays translocation of leukocytes across the blood–brain barrier in an animal model of acute bacterial meningitis

In bacterial meningitis, neurological damage is associated with a high influx of polymorphonuclear leukocytes (PMN) into the brain. Previous data suggest that the capsular component of the fungus C. neoformans, glucuronoxylomannan (GXM), interferes with PMN-migration into the cerebrospinal fluid (CSF). Therefore, a rabbit model of bacterial meningitis was treated intravenously with GXM. This resulted in (1) a reduction of PMN in the CSF at 6 h ( P=0.05), (2) reduced peak TNF-α concentrations in the CSF, and (3) diminished tissue inflammation and intravascular margination of PMN in GXM-treated animals. Thus, GXM may represent a novel adjuvant anti-inflammatory agent in bacterial meningitis.

Characteristics of the major etiologic agents of bacterial meningitis isolated in Poland in 1997-1998.

Bacterial meningitis remains a major cause of morbidity and mortality worldwide, especially in children. In this paper, we present the results of the first two years (1997-98) of activity of the National Reference Centre for Bacterial Meningitis (NRCBM) on the etiologic agents of bacterial meningitis in Poland. Of the 220 isolates sent to the NRCBM, the most frequently identified was Neisseria meningitidis (n = 90, 40.9%), followed by Haemophilus influenzae (n = 58, 26.4%), and Streptoccus pneumoniae (n = 46, 20.9%). Of the meningococcal isolates, 88.9% belonged to serogroup B and 10.0% to serogroup C, and the most prevalent serotype was 22 (43.3%). Most meningococci were highly sensitive to penicillin; however, 10% of them had decreased susceptibility to penicillin. More than 90% of H. influenzae belonged to serotype b, and all were susceptible to third generation cephalosporins and chloramphenicol. A broad distribution of serotypes was found among pneumococcal isolates, of which the most common were serotypes 3 and 8. Penicillin nonsusceptible isolates constituted 13% of all pneumococcal isolates. Three of the resistant pnemococci belonged to serotype 23F. Data presented in this paper demonstrate the current epidemiological situation of bacterial meningitis in Poland.

Limited efficacy of pentoxifylline as anti-inflammatory agent in experimental pneumococcal meningitis.

Dexamethasone appears to show some adverse side-effects as adjunctive anti-inflammatory agent in bacterial meningitis. For this reason, we tested the anti-inflammatory and neuroprotective effect of pentoxifylline administered 15 min before starting antibiotic treatment with ceftriaxone (n = 10) versus antibiotic therapy alone (n = 9) in the rabbit model of pneumococcal meningitis. Pentoxifylline lowered the medians of leucocyte density, tumour necrosis factor-alpha (TNF-alpha) and lactate in the cerebrospinal fluid (CSF), but only leucocyte migration into the subarachnoid space was significantly inhibited 8 h after initiation of therapy (P = 0.01). CSF protein, brain water content, and the entry of ceftriaxone into CSF were not influenced by pentoxifylline. The density of neuronal apoptoses in the dentate gyrus was slightly lower in animals receiving pentoxifylline than in those treated with ceftriaxone only. The median concentration of neuron-specific enolase in CSF was lower in the pentoxifylline-treated group, but the difference was not significant. In conclusion, pentoxifylline showed some anti-inflammatory activity in pneumococcal meningitis, but the substance failed significantly to reduce neuronal damage.

Letter to the Editor

Dr. Lindenbaum raises a point whose answer all would agree upon, namely when pneumococci or meningococci have been identified as the etiologic agent of bacterial meningitis, penicillin G is the simplest, cheapest, specific antimicrobial therapy. However, it is worth noting that in a controlled study of bacterial meningitis due to these agents ampicillin was an equivalent, albeit more expensive, alternate.