Suspected Meningitis Cases Research Articles

889 Evaluation of Meningitis Complications in Children Admitted Emergency Room of Ghaem&Imam Reza Hospital. Mashad Iran

Introduction: Meningitis is one of the most important emergencies in children. During the treatment of meningitis, acute complications such as hyponatremia subdural effusions, seizure and a prolonged fever may occur and cause irreparable sequels. Knowing these complications and there proper treatment can improve the prognosis of disease, therefore we decided to evaluate meningitis acute complications in study in one year period. Method: In this study 108 suspected meningitis cases in children who were admitted in children department of Imam Reza and Ghaem Hospitals were investigated. The data were collected using questionnaire and analyzed using SPSS. Materials and Results: Among the patients who were the suspected of meningitis the number of male patients(62%) was more than female patients(38%). Frequency of the disease in 3 to24 months old children was more than others(41%). The patients mostly presented with fever and seizure, Among the patients who were studied 57 of them were diagnosed as CNS infection an among them only 8 cases had positive cultures. The most common organism were Hemophilus influenza(28%). Hyponatremia (31 cases) is the most common complication followed by seizure(16 cases) and prolonged fever (one case) in patients with CNS infection.28% of patients with bacterial meningitis had subdural effusions in CTScan. The mean of HB value was sufficiently lower in patients with bacterial meningitis in comparison with patients with viral meningo encephalitis. Conclusion: During the treatment of meningitis hyponatrremia and seizure after treatment and subdural effusions should be considered.

Enhanced Diagnosis of Pneumococcal Meningitis with Use of the Binax NOW Immunochromatographic Test ofStreptococcus pneumoniaeAntigen: A Multisite Study

Accurate etiological diagnosis of meningitis in developing countries is needed, to improve clinical care and to optimize disease-prevention strategies. Cerebrospinal fluid (CSF) culture and latex agglutination testing are currently the standard diagnostic methods but lack sensitivity. We prospectively assessed the utility of an immunochromatographic test (ICT) of pneumococcal antigen (NOW Streptococcus pneumoniae Antigen Test; Binax), compared with culture, in 5 countries that are conducting bacterial meningitis surveillance in Africa and Asia. Most CSF samples were collected from patients aged 1-59 months. A total of 1173 CSF samples from suspected meningitis cases were included. The ICT results were positive for 68 (99%) of the 69 culture-confirmed pneumococcal meningitis cases and negative for 124 (99%) of 125 culture-confirmed bacterial meningitis cases caused by other pathogens. By use of culture and latex agglutination testing alone, pneumococci were detected in samples from 7.4% of patients in Asia and 15.6% in Africa. The ICT increased pneumococcal detection, resulting in similar identification rates across sites, ranging from 16.2% in Nigeria to 20% in Bangladesh. ICT detection in specimens from culture-negative cases varied according to region (8.5% in Africa vs. 18.8% in Asia; P< .001), prior antibiotic use (24.2% with prior antibiotic use vs. 12.2% without; P< .001), and WBC count (9.0% for WBC count of 10-99 cells/mL, 22.1% for 100-999 cells/mL, and 25.4% for >or=1000 cells/mL; P< .001 by test for trend). The ICT provided substantial benefit over the latex agglutination test and culture at Asian sites but not at African sites. With the addition of the ICT, the proportion of meningitis cases attributable to pneumococci was determined to be similar in Asia and Africa. These results suggest that previous studies have underestimated the proportion of pediatric bacterial meningitis cases caused by pneumococci.

Childhood Bacterial Meningitis in Ulaanbaatar, Mongolia, 2002–2004

Childhood bacterial meningitis is severe and largely preventable by vaccination. Few data on childhood bacterial meningitis in Northeast and Central Asia exist. Our aim was to determine the incidence and etiology of childhood bacterial meningitis in Ulaanbaatar, Mongolia. We conducted prospective, population-based, active hospital surveillance for clinical meningitis in children 2 months to 5 years of age. Clinical data, blood, and cerebrospinal fluid were collected according to a standard protocol. Laboratory testing was performed at 2 reference laboratories in Ulaanbaatar. From February 2002 to January 2005, 201 suspected meningitis cases were identified in residents of Ulaanbaatar. The average annual incidence rate for confirmed and probable bacterial meningitis (cases with culture-negative, purulent cerebrospinal fluid) was 68 cases per 100,000 children aged 2 months to 5 years. The average annual incidence rate of confirmed cases was 28 cases per 100,000 children for Haemophilus influenzae type b meningitis, 11 cases per 100,000 children for pneumococcal meningitis, and 13 cases per 100,000 children for meningococcal meningitis. Adjusting for cases without complete cerebrospinal fluid information and culture-negative, probable bacterial cases, the estimated incidence rate was 40 cases per 100,000 children for H. influenzae type b meningitis, 15 cases per 100,000 children for pneumococcal meningitis, and 17 cases per 100,000 children for meningococcal meningitis. H. influenzae type b is the leading cause of childhood bacterial meningitis in Ulaanbaatar, and the incidence rate is higher than that reported from other Asian countries. These data supported the recent introduction of H. influenzae type b conjugate vaccine in Mongolia. Ongoing surveillance will monitor the impact of the vaccine.

Laboratory-based surveillance for patients with acute meningitis in Sudan, 2004–2005

To determine the burden of bacterial meningitis and characterize its epidemiology, a laboratory-based surveillance was established in five hospitals in Sudan. Hospital personnel were trained in basic surveillance and bacteriology techniques. Positive cerebrospinal fluid (CSF) cultures were confirmed at Sudan National Laboratories and U.S. Naval Medical Research Unit No. 3. Additionally, 126 frozen CSF samples from culture-negative meningitis cases were tested by polymerase chain reaction (PCR). Of 1,830 suspected meningitis cases enrolled, 75% were less than 5 years old and 63% were males. Of these, 149 (8%) were culture-confirmed, including 121 (81%) Neisseria meningitidis; 18 (12%) Streptococcus pneumoniae, and 10 (7%) Haemophilus influenzae. Of 440 turbid specimens, 132 (30%) were culture-positive. Of the 126 samples from culture-negative meningitis cases that were tested, only 18 (14%) were classified as turbid on gross examination, yet 63 (50%) were positive by PCR. This study suggests that PCR may be useful to more accurately define the burden of disease in epidemic setting. Maintaining laboratory-based surveillance allows evidence-based decision-making and helps monitor the impact of new vaccines introduction.

ST2859 serogroup A meningococcal meningitis outbreak in Nouna Health District, Burkina Faso: a prospective study

We analysed cerebrospinal fluid samples from suspected meningitis cases in Nouna Health District, Burkina Faso, during the meningitis seasons of 2004-2006. Serogroup A ST2859 meningococci belonging to the ST5 clonal complex of subgroup III meningococci were the predominant causative agent. ST2859 bacteria were associated with focal outbreaks in the north of the district. While >10% of the population of an outbreak village carried ST2859, the population in the south of the district was predominantly colonised by serogroup Y ST4375 meningococci, which were associated with only sporadic cases of meningitis. Colonisation with the less virulent Y meningococci may interfere with the spread of the ST2859 to the south of the district, but there are concerns that this serogroup A clone may cause a third wave of subgroup III meningococcal disease in the African Meningitis Belt.

LATEX PARTICLE AGGLUTINATION TEST AS AN ADJUNCT TO THE DIAGNOSIS OF BACTERIAL MENINGITIS

The present study aimed to review the results of microscopic examination, routine culture and antigen detection by latex particle agglutination test (LPAT), in order to evaluate the diagnostic value of the LPAT in establishing the aetiological diagnosis of bacterial meningitis. LPAT was done in 65 clinically suspected meningitis cases ranging from 5 days to 60 years of age and was compared with culture and Gram stain. Using LPAT, an aetiological diagnosis could be done in 10 out of 65 (15.4%) cases of bacterial meningitis. In contrast, Gram stain and culture showed 16.9 and 23.1% positivity, respectively. LPAT correlated well with Gram stain and culture and can be recommended as an adjunct laboratory test for rapid aetiological diagnosis of bacterial meningitis for prompt institution of proper antibiotics.

Evaluation of the Wayson Stain for the Rapid Diagnosis of Melioidosis

Melioidosis is a significant cause of morbidity and mortality in east Asia and northern Australia (8). Early diagnosis is vital if patients are to receive effective treatment. Definitive laboratory diagnosis is based on the isolation of Burkholderia pseudomallei, but culture is often slow or not available in these regions. Techniques such as direct immunofluorescence (DIF) (9) and urinary antigen enzyme-linked immunosorbent assays (5) allow a rapid provisional diagnosis to be made with acceptable levels of accuracy but are expensive and not widely available. Rapid, cheap diagnostic methods are still needed. Direct microscopy using Gram staining may be helpful if typical slender, pale, bipolar-staining bacilli are seen, but this technique lacks specificity (7). The Wayson stain is a simple, cheap, modified methylene blue stain, originally used for diagnosing murine plague (6). Wayson staining gave better sensitivity than Gram staining did in suspected meningitis cases in one study (3). U.S. Army pathologists in Vietnam recommended the use of the Wayson stain (with the Gram stain) in cases of melioidosis (1) but did not report a formal assessment. We report a randomized, blind comparison of the Wayson and Gram stains for rapid diagnosis of melioidosis in an area of endemicity. Clinical specimens were collected from patients with suspected melioidosis who had been admitted to Sappasithiprasong Hospital, Ubon Ratchathani, Thailand (Table ​(Table1).1). Air-dried, heat-fixed smears were prepared for staining or DIF. B. pseudomallei was isolated and identified as described previously (4, 7). Paired slides were stained either with a modified Gram stain (with a neutral red counterstain) (7) or with the Wayson stain (2) for 10 seconds, rinsed in water, and air dried. Randomized slides were examined blind by three separate observers. Interobserver measures of agreement were assessed by means of the kappa statistic. TABLE 1. Types of specimen examined One hundred thirty-two consecutive specimens from 95 patients were included (Table ​(Table1).1). B. pseudomallei was isolated from 40 specimens (30%). The results for sensitivity, specificity, positive predictive value, negative predictive value, and Youden's J index (10) based on determinations by three observers for each stain were generally poor compared to the results of culture and are shown in Table ​Table2.2. Excluding sputum specimens or specimens with visible gram-positive diplococci because of a possible false-positive bipolarity did not enhance the diagnostic accuracy of either stain (data not shown). TABLE 2. Comparison of Gram and Wayson stain results with culture resultsa DIF results were available for 110 specimens. The results of comparisons between Gram and Wayson stain results and DIF results were similar to those of comparisons made between stain results and those of culture (data not shown). There was satisfactory agreement between the three observers regarding the results of the Gram stain (Κ = 0.72) but not regarding those of the Wayson stain (Κ = 0.36), suggesting considerable variability in interpretation of the latter. Our results suggest that the Gram and Wayson stains are both insufficiently sensitive and specific, compared to either culture or to DIF, to be relied upon for rapid presumptive diagnoses in cases of suspected melioidosis. Even when corrected for the presence of gram-positive diplococci, the sensitivity approached approximately 50% at best. Combining Gram and Wayson stain results did not significantly improve the diagnostic sensitivity. We also found a wide variation in the reporting of the presence of bipolar rods based on the Wayson stain, which may represent a lack of familiarity with the stain but which further limits its potential utility.

Latex particle agglutination test as an adjunct to the diagnosis of bacterial meningitis

The present study aimed to review the results of microscopic examination, routine culture and antigen detection by latex particle agglutination test (LPAT), in order to evaluate the diagnostic value of the LPAT in establishing the aetiological diagnosis of bacterial meningitis. LPAT was done in 65 clinically suspected meningitis cases ranging from 5 days to 60 years of age and was compared with culture and Gram stain. Using LPAT, an aetiological diagnosis could be done in 10 out of 65 (15.4%) cases of bacterial meningitis. In contrast, Gram stain and culture showed 16.9 and 23.1% positivity, respectively. LPAT correlated well with Gram stain and culture and can be recommended as an adjunct laboratory test for rapid aetiological diagnosis of bacterial meningitis for prompt institution of proper antibiotics.

Practice patterns and management of aseptic meningitis in a pediatric emergency department

Study objectives: Data describing the pediatric emergency department (ED) practice patterns and management in aseptic meningitis are limited. We evaluate use of diagnostic tests, antibiotic use, and ED disposition in an urban pediatric ED. Methods: This was a retrospective review of patients with an International Classification of Diseases, Ninth Revision discharge diagnosis of aseptic meningitis during January 1, 1996, and December 31, 2000, in an urban pediatric teaching hospital. Results: Sample size was 131 cases (56% male patients). More than 75% of patients presented during August to October. Seventy-two percent of patients presented complaining of 1 or more of the following symptoms; fever, stiff neck, headache, or vomiting, and average duration of symptoms before presentation was 48 hours. Classic examination findings of meningeal irritation were found in less than 16% of patients. Cranial computed tomography (CT) was ordered in 21% of suspected meningitis cases with normal level of consciousness, and no abnormalities were found. Median circulating WBC count was 10,800 cells/mL. Median cerebrospinal fluid WBC count was 345 cells/mL. The most common antibiotic administered was Ceftriaxone (63%). Rapid antigen tests were used in only 53% of children. Enteroviral polymerase chain reaction was used in only 53% of cases. Herpes virus polymerase chain reaction was ordered in 6 cases, and 1 length of stay was 3 days. Thirty-three percent of patients were admitted to the general medical floor, and 23.5% were sent home from the ED. Seventy-nine percent of patients were continued on Ceftriaxone as an inpatient until cerebrospinal fluid studies were completed. Ninety percent of patients were discharged without antibiotics. Conclusion: Aseptic meningitis has a benign presentation, and use of lumbar puncture may account for seasonal preponderance. Use of cranial CT is limited but appropriately so. Rapid adjunct diagnostic tests are ordered infrequently. New strategies to standardize ED care and reduce unnecessary laboratory tests are needed.

Microheterogeneity of serogroup A (subgroup III) Neisseria meningitidis during an outbreak in northern Ghana

During a meningitis outbreak in the eastern subdistrict of the Kassena-Nankana District of the Upper East Region of Ghana, we analysed cerebrospinal fluid from suspected meningitis cases for the most common causative organisms. In 50 of 92 samples analysed, serogroup A Neisseria meningitidis were detected. The ages of serogroup A N. meningitidis patients ranged from 4 months to 64 years. The case fatality ratio was 20%. Coma or stupor on presentation worsened the prognosis. All serogroup A N. meningitidis isolates recovered revealed the A: 4: P1.9, 20 phenotype characteristic for the subgroup III clonal grouping. No evidence for resistance to penicillin G, chloramphenicol, cefotaxime, ciprofloxacin, rifampicin or tetracycline was found. All strains were resistant to sulphadiazine. Restriction analysis patterns of opa, iga and ingA genes were characteristic for the majority of N. meningitidis serogroup A subgroup III bacteria isolated in Africa after the 1987 epidemic in Mecca. Differences in pulsed-field gel electrophoresis patterns of NheI and SpeI digested DNA revealed microheterogeneity among the Ghanaian isolates.

Detección de antígenos de Neisseria meningitidis del grupo B con la prueba MB-Dot-ELISA en pacientes con meningitis

Infection with Neisseria meningitidis group B has been difficult to detect, partly because this bacterial group's polysaccharide is a weak immunogen. This article describes work carried out to test a new procedure (MB-Dot-ELISA) employing a high-titered horse antiserum for detection of N. meningitidis group B antigens. The study assayed cerebrospinal fluid samples from 585 subjects, 574 with suspected meningitis cases and 11 with neurologic disorders. The results of the assay indicated a sensitivity of 0.991 and a specificity of 0.826. These results were superior to those obtained with latex agglutination and in substantial agreement with the results of counterimmunoelectrophoresis and bacteriologic methods. Overall, the MB-Dot-ELISA was found to be sensitive, inexpensive, and suitable for public health laboratory investigations.

Detection, Antimicrobial Susceptibility and Serotyping of &lt;i&gt;Streptococcus pneumoniae&lt;/i&gt; from Cerebrospinal Fluid Specimens from Suspected Meningitis Patients

Pneumococcal meningitis is the most important cause of community-acquired meningitis in children resulting in high morbidity and mortality worldwide. This study aimed to evaluate immunochromatographic test (ICT), a rapid detection method, for pneumococci in cerebrospinal fluid (CSF) and also to assess antibiotic susceptibility pattern of the clinical isolates. The findings of CSF-ICT of suspected meningitis cases were also compared with the results of CSF culture, latex agglutination test (LAT) and polymerase chain reaction (PCR). Among these diagnostic methods, ICT and PCR showed 100% specificity. A total of 401 CSF specimens were cultured but culture positivity was observed with 55 (13.7%) cases in which Streptococcus pneumoniae was identified from 20 (36.4%) culture-positive cases. A remarkably high resistance rate to gentamicin (95%) and cotrimoxazole (60%) among the invasive strains of S. pneumoniae was observed, while none of the isolates exhibited resistance to penicillin, ceftriaxone and chloramphenicol by disk diffusion test. Minimum inhibitory concentration (MIC) showed similar susceptibility pattern. The invasive strains (n = 18) belonged to 9 different serotypes including 1, 2, 4, 34, 12A, 38, 19F, 35A and 45. The prevalent serotypes were 2 (23.5%), 1 (17.6%) and 45 (11.8%). The study shows that a remarkable proportion of meningitis cases in children are caused by S. pneumoniae. Diagnostic methods like ICT and PCR can be considered as effective methods for the detection of pneumococcal meningitis even with the patients who have been treated with empirical antibiotics. Ceftriaxone is a safe choice for empirical therapy, while the use of cotrimoxazole for the treatment of meningitis infections is debatable. Keywords: Pyogenic meningitis, Cerebrospinal fluid (CSF), Streptococcus pneumoniae Immunochromatographic test (ICT), Polymerase chain reaction (PCR), SerotyingDOI: http://dx.doi.org/10.3329/bjm.v24i1.1232 Bangladesh J Microbiol, Volume 24, Number 1, June 2007, pp 24-29