There is a paucity of data on etiology of acute bacterial meningitis (ABM) in different regions of the country. In this retrospective study, we report the etiology and outcome of children with ABM hospitalized in a secondary care private sector pediatric hospital in Western Uttar Pradesh.

All children above 1 month of age, admitted from January 2009 through December 2010, with clinical and laboratory evidence of ABM were included. Cases were categorized as ‘suspected’, ‘probable’ and ‘confirmed’ ABM based on published criteria [1]. Cerebrospinal fluid (CSF) culture and latex agglutination test (LAT) were done to identify etiological agents.

Among 3543 admissions, 67 (1.9%) met the inclusion criteria of probable ABM cases; 46 (68.7%) were males. Thirty-six cases had cell CSF count <100 and therefore not included in this analysis. History of immunization was available in only 10 cases; however, none had received Hib or pneumococcal vaccines. The mean (SD) age of children was 41.5 (± 26.9) months. Seasonality was evident as 41 (61.2%) cases occurred during September to November. Fever (91%), altered sensorium (62.7%), vomiting (50.8%), seizures (47.8%) and refusal of feeds (23.9%) were main presenting features. Circulatory collapse was present at admission in three children. Neck rigidity and Kernig’s sign were noted in 31.3% and 22.4% of cases, respectively. In infants, bulging anterior fontanel was the most frequent clinical sign, present in (75.8 %) (25 out of 33). History of having been treated with some antibiotics prior to admission was recorded in 24 (35.8 %) patients. The CSF was turbid in 27 (40.3%) cases. Gram stain detected bacteria in 29 (43.3%) cases; Gram positive diplococci (n=12), Gram positive cocci in clusters (n=3), Gram negative diplococcic (n=2), Gram negative rods (n=10) and Gram negative coccobacilli (n=2). However, the Gram stain results correlated poorly with culture and LAT results.

Etiological diagnosis based on CSF culture or LAT was established in 30 (44.8%) children. CSF culture was positive in 24 (35.82%) cases out of 67 and LAT was positive in 6 (42.85 %) out of the 14 cases where it was employed. Streptococcus pneumoniae was found in 17 (25.37%), Haemophilus influenzae type b in 3 (4.5%), Neisseria meningitides in 2 (3%), Escherichia coli in 5 (7.5%) and Staphylococcus aureus, Klebsiella and Pseudomonas in one case each.

All children were treated according to standard protocol. The duration of stay ranged from 5 to 16 days, average 9 days). The most frequent complication during hospital stay was persistent focal seizures (n=8). There were 7 (10.5%) deaths; 4 in children less than one year of age. In these seven children, S. pneumoniae was isolated from CSF in three cases and E. coli and Klebsiella in one each.

In this small hospital based study, we documented pneumococcus to be the most frequently isolated pathogen in ABM. Other studies from Northern India documented similar pattern of pneumococcal predominance [2-5]. Large-scale multi-centric studies are needed to define the etiology of ABM in diverse settings in order to make policy decisions on the appropriate preventive and therapeutic strategies.

1. World Health Organization, Global Programme for Vaccines and Immunization Vaccine Research and Development. Generic Protocol for Population-based Surveillance of Haemophilus influenzae type b. Geneva: World Health Organization; 1996. WHO/VRG/GEN/95.05.

2. Kalra K, Dayal RS. Purulent meningitis in infancy and childhood. Indian J Pediatr. 1977;44:65-70.

3. Taneja PN, Ghai OP. Pyogenic meningitis. Indian J Pediatr. 1955;22:99-106.

4. Paul SS. Pyogenic meningitis in children. A study of 48 cases. Indian J Child Health. 1963;12: 98-103.