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Indian Pediatr 2014;51:
757 |
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Neonatal Meningitis due to Neisseria
meningitidis Serogroup Y
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Utpala Devi and Jagadish Mahanta
Regional Medical Research Centre, NE Region (ICMR),
Post Box-105, Dibrugarh-786001, Assam, India.
Email: [email protected]
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Neonatal meningococcal meningitis is very rare; among
the existing 13 serogroups of Neisseria meningitidis, serogroups
B, C and Y have been reported in neonatal meningococcal meningitis
[1-3]. Here we report isolation of N. meningitidis serogroup Y
from the cerebrospinal fluid of a neonate which to the best of our
knowledge is the first report from India. This could alert the
clinicians to keep an index of suspicion for this bacterium in the
etiology of neonatal meningitis.
A 38-week-gestation male baby, born by Caesarean
section to a 32 year old multigravida in a district hospital with a
birth weight of 2500 grams, presented on 14th day of life with symptoms
of lethargy and refusal to feed. He had no history of seizure, apnea, or
fever. On examination he had bulging anterior fontanel and hypotonia. He
was afebrile and no skin rash or petechiae was seen. Sepsis screen was
found positive with a C-reactive protein value of 2.76 mg/dL (Normal:
0.5mg/dL). The total leucocyte count was 4485 cells/ mm 3.
Blood culture was negative. The CSF biochemical and cytological para-meters
revealed protein 65 mg/dL, sugar 35 mg/dL, and a cell count of 4cells/mm3
(all lymphocytes).No bacteria were seen on direct Gram staining. CSF
culture showed growth of Neisseria meningitidis whose
identification was based on colony appearance, gram stain and
biochemical tests. Identification was confirmed using polymerase chain
reaction targeting the conserved regulatory gene crg A using
established primers [4]. Slide agglutination with N. meningitidis
antisera (Difco, BD Diagnostics) confirmed it as N. meningitidis
Serogroup Y. Nasopharyngeal swabs from both parents were negative for
the bacterium. The neonate recovered following treatment with amikacin
for 7 days and piperacillin-tazobactam for 21 days.
To the best of our knowledge there exists only one
previous case of neonatal meningitis associated with sepsis due to
Serogroup Y who had a favourable outcome [3]. Previous authors have
remarked on the importance of a lumbar puncture to avoid missing the
diagnosis in this age group [5]. In the present case, even though the
CSF biochemical parameters were not suggestive of meningitis, culture
was helpful and demonstrated the existence of this rare pathogen.
Acknowledgement: The authors acknowledge
Dr Reeta Bora, Associate Professor of Pediatrics, Assam Medical College,
Dibrugarh for providing us clinical details of the patient and for her
inputs in preparing the manuscript.
References
1. Tinsa F, Jallouli M, Ben Lassouad M, Smaoui H, Brini
I, Bousseta K, et al. Neonatal meningitis by Neisseria
meningitidis B. Tunis Med. 2008;86:1014-5.
2. Falcao MC, Andrade SB, Ceccon ME and Costa Vaz FA.
Neonatal sepsis and meningitis caused by Neisseria meningitidis:
a case report. Rev Inst Med Trop S Paulo. 2007;49:191-4.
3. Bosman M, Archary M, Mahabeer P, Bobat RA. Early
onset meningococcal meningitis. South Afr J Epidemiol Infect.
2013;28:177-9.
4. Taha MK. Simultaneous approach for nonculture
PCR-based identification and serogroup prediction of Neisseria
meningitidis. J Clin Microbiol. 2000;38:855-7.
5. Kumar S. Missed and delayed diagnosis of neonatal meningitis.
Indian Pediatr. 2004; 41:959-60.
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