Meningitis In Countries Research Articles

The Role of Molecular Testing in Pediatric Meningitis Surveillance in Southern and East African Countries, 2008-2017.

BackgroundAs part of the global Invasive Bacterial Vaccine-Preventable Diseases Surveillance Network, 12 African countries referred cerebrospinal fluid (CSF) samples to South Africa’s regional reference laboratory. We evaluated the utility of real-time polymerase chain reaction (PCR) in detecting and serotyping/grouping Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae (HNS).MethodsFrom 2008 to 2017, CSF samples collected from children <5 years old with suspected meningitis underwent routine microbiology testing in-country, and 11 680 samples were submitted for HNS PCR at the regional reference laboratory. Unconditional logistic regression, with adjustment for geographic location, was performed to identify factors associated with PCR positivity.ResultsThe overall HNS PCR positivity rate for all countries was 10% (1195 of 11 626 samples). In samples with both PCR and culture results, HNS PCR positivity was 11% (744 of 6747 samples), and HNS culture positivity was 3% (207 of 6747). Molecular serotype/serogroup was assigned in 75% of PCR-positive specimens (762 of 1016). Compared with PCR-negative CSF samples, PCR-positive samples were more often turbid (adjusted odds ratio, 6.80; 95% confidence interval, 5.67–8.17) and xanthochromic (1.72; 1.29–2.28), had elevated white blood cell counts (6.13; 4.71–7.99) and high protein concentrations (5.80; 4.34–7.75), and were more often HNS culture positive (32.70; 23.18–46.12).ConclusionPCR increased detection of vaccine-preventable bacterial meningitis in countries where confirmation of suspected meningitis cases is impeded by limited culture capacity.

Serotype Distribution of Remaining Pneumococcal Meningitis in the Mature PCV10/13 Period: Findings from the PSERENADE Project.

Pneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5–7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites (N = 8; cases = 1141), PCV10 types caused 5% of cases <5 years of age and 15% among ≥5 years; the top serotypes were 19A, 6C, and 3, together causing 42% of cases <5 years and 37% ≥5 years. In PCV13-using sites (N = 32; cases = 4503), PCV13 types caused 14% in <5 and 26% in ≥5 years; 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed.

To LP or not to LP? Identifying the Etiology of Pediatric Meningitis.

Introduction of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to a substantial reduction in cases of acute bacterial meningitis in countries with high routine childhood immunization coverage. The majority of children hospitalized with meningitis in high-income countries have viral or aseptic meningitis and do not require antibiotic treatment. Cerebrospinal fluid analysis is irreplaceable in appropriately diagnosing and treating bacterial meningitis and avoiding unnecessary antibiotics and prolonged hospitalizations in children with viral meningitis. New diagnostic tests have improved detection of bacterial and viral pathogens in cerebrospinal fluid, underscoring the importance of promptly performing lumbar puncture when meningitis is suspected. This article provides an overview of acute bacterial and viral meningitis in children, focusing on the changing epidemiology, the advantages and limitations of conventional and newer diagnostic methods, and considerations for clinical practice.

Streptococcus pneumoniae Serotype-2 Childhood Meningitis in Bangladesh: A Newly Recognized Pneumococcal Infection Threat

Background Streptococcus pneumoniae is a leading cause of meningitis in countries where pneumococcal conjugate vaccines (PCV) targeting commonly occurring serotypes are not routinely used. However, effectiveness of PCV would be jeopardized by emergence of invasive pneumococcal diseases (IPD) caused by serotypes which are not included in PCV. Systematic hospital based surveillance in Bangladesh was established and progressively improved to determine the pathogens causing childhood sepsis and meningitis. This also provided the foundation for determining the spectrum of serotypes causing IPD. This article reports an unprecedented upsurge of serotype 2, an uncommon pneumococcal serotype, without any known intervention.Methods and FindingsCases with suspected IPD had blood or cerebrospinal fluid (CSF) collected from the beginning of 2001 till 2009. Pneumococcal serotypes were determined by capsular swelling of isolates or PCR of culture-negative CSF specimens. Multicenter national surveillance, expanded from 2004, identified 45,437 patients with suspected bacteremia who were blood cultured and 10,618 suspected meningitis cases who had a lumber puncture. Pneumococcus accounted for 230 culture positive cases of meningitis in children <5 years. Serotype-2 was the leading cause of pneumococcal meningitis, accounting for 20.4% (45/221; 95% CI 15%–26%) of cases. Ninety eight percent (45/46) of these serotype-2 strains were isolated from meningitis cases, yielding the highest serotype-specific odds ratio for meningitis (29.6; 95% CI 3.4–256.3). The serotype-2 strains had three closely related pulsed field gel electrophoresis types.Conclusions S. pneumoniae serotype-2 was found to possess an unusually high potential for causing meningitis and was the leading serotype-specific cause of childhood meningitis in Bangladesh over the past decade. Persisting disease occurrence or progressive spread would represent a major potential infection threat since serotype-2 is not included in PCVs currently licensed or under development.

The Journal and the Rest of the World

Neurocritical Care is the official journal of Neurocritical Care Society-an international organization. The society is expanding its wings toward all countries and the journal is a reflection of that. Although the journal is US made and US maintained, scientific articles from countries of the world outside the US are omnipresent. We like to think of ourselves as an international journal. What are arguments for that? First, our contributors are increasingly from outside the US. In 2009, more than 50% of all total submissions were from multiple regions of the globe—36 countries to be more precise—with Germany taking the top spot. (This is not unexpected with the well organized Deutsche Gesellschaft fur Neurointensiv und Notfallmedizin currently presided by Professor Stefan Schwab.) Second, our editorial board has representatives from all continents and from many countries with active neurocritical care programs. Neurointensive care may not be as well organized in other countries due to financial constraints, lack of organizational structure and perhaps politics, but courses are abound and dedicated to the care of the critically ill neurologic patient. We can expect some significant catching up in the next decade. Third, an introductory free 1 year membership is offered to major European critical care organizations. This is good for neurocritical care, good for international authors, and obviously good for the journal. We also encourage articles from developing countries. Care of critically ill neurologic patients is the same everywhere although armed conflict may have increased traumatic head injury, spinal cord injury, and associated CNS infections. Meningococcal meningitis in countries with low vaccination rates are common and of our concern. We should be the first journal to present data on the management of the polio (or is it West-Nile?) epidemic in the republic of Congo. But we know too well that stroke, and stroke again are the most common acute neurologic problems in developing countries. We will be publishing articles addressing some of these major issues next year. When we encourage authors from foreign countries to contribute, we recognize there is a longstanding problem with the English language. So how can international authors improve their chances? No editor will get encouraged by poorly written, poorly prepared articles and we do get them every once in a while. Writing articles is not only good data presentation, but also good and interesting English. We do like to assist and we try to avoid a biased peer review, but authors should find a native English speaker to help. This editorial would be amiss not to look back on last year. For impact factor afficiados, we were pleased that our impact factor increased to 2.17 and has been rising steadily. Our submissions continue to grow at an annual 20–30% rate while keeping the number of rejected articles to a bare—but necessary—minimum. If the number of submissions will continue to grow at this rate, we will move to eight issues a year and eventually monthly. This change may seem small, but the logistic problems are much greater and will have to be solved in order to proceed. I cannot resist the temptation to relate why I believe we are on the radar screen. Our journal is clinically useful for neurointensivists, fellows and residents, and we have an unprecedented turn around time. We will continue to get good articles reviewed as quick as possible and no one should have to wait. We have been fortunate to publish randomized trials—an unmistaken luxury for a new E. F. M. Wijdicks (&) Mayo Clinic, Rochester, USA e-mail: wijde@mayo.edu

Akute bakterielle Meningitis: Neues aus Forschung und Klinik

Until the introduction of antibiotics in the 1930 s and 1940 s, acute bacterial meningitis was fatal in the vast majority of cases. Since then it has become curable with a variable mortality and morbidity rate depending on individual pathogens and patients. During the past 20 years, we have witnessed significant changes in the epidemiology and treatment of acute bacterial meningitis. The most important epidemiological changes are (I) the near-eradication of meningitis due to HAEMOPHILUS INFLUENZAE type B as well as the decline in the incidence of pneumococcal and meningococcal meningitis in countries that have introduced the respective immunisation programmes, and (II) the emergence of antimicrobial resistance among meningeal pathogens which is of particular importance for the clinical management of the disease. The major therapeutic change is that adjuvant dexamethasone therapy has been demonstrated to be beneficial, particularly in adults with pneumococcal meningitis. It became also evident that time from arrival at the hospital to administration of the first dose of antibiotics is a crucial independent factor that influences outcome. Here we review (I) the epidemiological characteristics of acute bacterial meningitis, (II) the impact of vaccination programmes on the epidemiology, (III) the clinical and laboratory presentation of the disease and (IV) the antibiotic regimens and adjuvant treatment options that are currently recommended for its treatment. We further review (V) current concepts of the pathophysiology of the disease - using the example of pneumococcal meningitis - with an emphasis on promising targets for novel adjunctive therapy in acute bacterial meningitis.

Changing epidemiology of bacterial meningitis

Immunization against the most common meningeal pathogens is the leading factor associated with decreased incidence of bacterial meningitis in countries where routine vaccination is available. This is most dramatically illustrated by the reduction in the incidence of Haemophilus influenzae type b meningitis. The incidence of bacterial meningitis has decreased by 55% since the introduction of the H. influenzae type b conjugate vaccine in 1990. H. influenzae occurred primarily in children younger than 5 years of age, and so the median age of patients with bacterial meningitis has now increased to 39 years of age in the United States, and the leading pathogen is currently Streptococcus pneumoniae. Three other control measures (ie, universal screening and antibiotic prophylaxis of pregnant women for Group B streptococci and the implementation and availability of the S. pneumoniae and Neisseria meningitidis conjugate vaccines) have likely further decreased the incidence of these meningeal pathogens. Lastly, the worldwide emergence of multidrug-resistant pneumococci has complicated the empiric therapy of bacterial meningitis.

Pneumococcal Meningitis Epidemics in Africa

Outbreaks of meningococcal meningitis are not uncommon. In industrialized countries, epidemics increase and decrease in severity slowly over a number of years and rarely achieve very high incidence rates of disease. In sub-Saharan Africa, the situation is different. Within the African meningitis belt, which extends across the Sahel and sub-Sahel from Ethiopia in the east to The Gambia in the west, major epidemics of meningococcal disease occur every few years [1]. These epidemics show a characteristic association with season. They almost always start early in the dry season, build to a peak at the hottest and driest time of the year, and then abate rapidly with the onset of the rains [2]. The reason for this remarkable seasonality is unknown, but climatic factors—in particular, a low absolute humidity—almost certainly play a central role [3]. In contrast, pneumococci are not usually considered to be a cause of meningitis epidemics. Outbreaks of invasive pneumococcal disease are reported from time to time in industrialized countries among people living in poor social circumstances, such as centers for the indigent, prisons, and military camps, but these outbreaks usually involve only a handful of cases. Thus, the recent reports of major outbreaks of pneumococcal meningitis in countries located in the African meningitis belt that have many of the epidemiological features of classic meningococcal epidemics are of concern [4, 5]. Surveillance of cases of meningitis and longitudinal surveys of nasopharyngeal carriage of meningococci have been underway in the Kassena-Nankana region of northern Ghana since 1998. Carriage studies have shown fluctuations in the prevalence of meningococci of different serogroups and sequence types over time, including a wave of infections caused by meningococci belonging to serogroup X [6, 7]. Surveillance of admissions to the district hospital showed a marked increase in the number of cases of pneumococcal meningitis in 2002 and 2003; 1100 patients were seen during this 2-year period [4]. All age groups were affected, and the case fatality rate of 44% was high. A strong association with season was observed; an increase in the number of cases of pneumococcal meningitis occurred approximately a month before there was an increase in the number of cases of meningococcal meningitis. Examination of the pneumococci responsible for this outbreak showed that 76% of isolates belonged to serogroup 1. On multilocus sequence typing, most isolates belonged to a single sequence type, ST217, and its 2 single-locus variants ST303 and ST612. Recently, the number of cases of meningitis caused by pneumococci of this serotype has decreased in the study area (G. Plutschke, personal communication), which suggests a natural cycle of penetration of a susceptible population by a new strain of bacteria and its subsequent elimination as a result of naturally acquired immunity; no pneumococcal vaccination has been undertaken. Unusual events have also been taking

Serum C-reactive protein in childhood meningitis in countries with limited laboratory resources: A chilean experience: I Roine, A Banfi, P Bosch, et al Pediatr Infec Dis J 10:923–928 Dec 1991

Serum C-reactive protein in childhood meningitis in countries with limited laboratory resources: A chilean experience: I Roine, A Banfi, P Bosch, et al Pediatr Infec Dis J 10:923–928 Dec 1991

Serum C-reactive protein in childhood meningitis in countries with limited laboratory resources

Quantitative C-reactive protein (CRP) was determined sequentially by nephelometry and photometry from a finger prick serum sample in 67 children with bacterial meningitis (BM) and 16 children with aseptic meningitis (AM). The initial mean CRP value of 180 mg/liter in children with BM differed significantly from the 12 mg/liter found in those with AM (P less than 0.001). In BM a slow descent instead of rapid normalization or a secondary increase in sequential CRP values were early indicators of complications during recovery, such as resistance to the antibiotic. A significant difference in the mean CRP values between uneventful and complicated courses of BM was observed from the fourth day on (P less than 0.001). The measurements obtained with nephelometry correlated reliably with the more widely available photometry (r = 0.99). Easily performed rapid CRP determinations can considerably improve the quality of care in meningitis patients, especially in those situations where facilities for performing bacterial cultures or antibiotic susceptibility testing are not available.