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Indian Pediatr 2011;48:
985-986 |
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Etiology of Acute Bacterial Meningitis in
Hospitalized Children in Western Uttar Pradesh |
*Vipin M Vashishtha, **Amit Garg, and
#T Jacob John
From the *Department of Pediatrics, Mangla Hospital and
Research Center, Bijnor, **Department of Microbiology, LLRM Medical
College, Meerut, UP and #Department
of Clinical Virology, Christian Medical College, Vellore.
Correspondendence to:
[email protected]
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We retrospectively studied clinical and etiological profile of acute
bacterial meningitis in hospitalized children for two consecutive years
at a pediatric hospital in western Uttar Pradesh. Etiological diagnosis
could be made in 30 (44.8%) out of 67 cases with either culture or latex
agglutination test. Pneumococcus was the commonest pathogen found in 17
(25. 4%) cases. The overall mortality was 10. 5%.
Key words: Epidemiology, Pneumonococcus, Pyogenic
Meningitis.
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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.
TABLE I Age-Wise Distribution of Cases with Causative Organisms
Age-group |
Cases |
Hemophilus
influenzae
type b(n=3) |
Streptococcus
pneumoniae
(n=17) |
Neisseria
meningitides
(n=2) |
Others #
(n=8) |
Probable* |
Confirmed** |
(n=67) |
(n=30) |
1-3 mo |
15 |
7 |
0 |
0 |
0 |
7 |
3-12 mo |
18 |
8 |
2 |
5 |
0 |
1 |
1-5 y |
17 |
8 |
1 |
5 |
2 |
0 |
5-18 y |
17 |
7 |
0 |
7 |
0 |
0 |
*Probable case: a suspected case with CSF leukocytosis of >100
WBC/cmm, protein >100 mg/dL, or glucose <40 mg/dL; ** Confirmed case:
a probable case with a positive bacterial isolate in CSF culture or
positive latex agglutmation test; #Others: Gram negative bacilli (n=7)
and Staphylococcus aureus (n=1). |
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.
References
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.
5. Kabra SK, Kumar P, Verma IC, Mukherjee D, Chowdhary
BH, Sengupta S, et al. Bacterial meningitis in India: An IJP
survey. Indian J Pediatr. 1991;58:505-11.
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