Epidemiological profile of acute bacterial meningitis in the state of Rio Grande do Norte, Brazil

Abstract

Acute bacterial meningitis (ABM) is a public health problem worldwide and, in Brazil, in the 1990s, an average of 28,000 cases of meningitis were reported annually 1 . In an etiological survey in northeastern Brazil in the 1980s, Bryan et al 2 reported that N. meningitides (meningococcus) was the most prevalent ABM pathogen, followed by Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (pneumococcus) 2 . However, after the introduction of the anti-Hib conjugated vaccine to the public vaccination program in 1999, there was a significant decrease in the incidence of cases of ABM due to H. influenzae in Brazil 3 .Because of the high mortality rate and long-term sequels, fast and accurate diagnosis and appropriate treatment of ABM are fundamental for a good outcome 4 . The initial antibiotic regimen is usually empirical, and therefore, knowledge of the epidemiological profile of ABM in the community could lead to the best therapeutic choice 5 .In the present study, we describe the epidemiological profile of ABM at Giselda Trigueiro Hospital (GTH), a reference center for infectious diseases in the State of Rio Grande do Norte, Brazil, between 2005 and 2008. We are not aware of any previous study on the epidemiology of ABM in this Brazilian state.This study consisted of a descriptive retrospective survey of the cases of ABM that were attended at GTH between 2005 and 2008. During the period of this study, the hospital could not afford a pediatric ward, and children were sent to pediatric hospitals after diagnosis and initial treatment.Information on age, sex, home location (rural or urban area), laboratory results, criteria for diagnostic confirmation, previous use of antibiotics and outcome were collected from the official records of the Brazilian compulsory notification system (SINAN), which were available in the hospital' s epidemiology department. The data were analyzed through SPSS (Statistical Package for the Social Sciences), version 13.0.The diagnoses of cases with clinical signs and symptoms of ABM were confirmed in accordance with at least one of the following criteria: 1) cerebrospinal fluid (CSF) culture; 2) CSF Gram stain; 3) blood culture or blood Gram stain; 4) latex agglutination test on CSF; and 5) CSF presenting pleocytosis (> 500 cells/mm 3 ), predominantly polymorphonuclear neutrophils, protein level > 40mg/dl and glucose level < 40mg/dl. Two cases did not fit the above criteria and their diagnosis were confirmed post-mortem by means of autopsy.Blood and CSF were seeded in chocolate agar enriched with 5% sheep blood. The latex agglutination test was used to identify polysaccharide antigens from N. meningitides, S. pneumoniae and Hib in CSF. Gram's method consisted of a primary stain with crystal violet, followed by the addition of iodine, rapid decolorization with acetone, and staining with basic fuchsin.The antibiotic susceptibility of the S. pneumoniae was identified by means of the disk diffusion method, in accordance with the definitions of the National Committee for Clini...

Investigation of Bacterial Meningitis Agents from Patients with Suspicion of Non-Neonatal Meningitis by Conventional and Molecular Methods

“…Öncesinde antibiyotik kullanımı ile bu oran %20'lere kadar düşmektedir (9) . Çeşitli çalışmalara %4.1 (20) , %40.4 (21) , %65.7 (22) gibi çok farklı oranlarda tanıya katkısı bildirilmiştir. Çalışmamızda, 19 hastanın 5 (%26.3)'inde Gram boyama ile mikroorganizma belirlenmiştir.…”

Causative agents of bacterial meningitis

“…The golden standard for diagnosis is culturing the growth of the causative agent from CSF. Isolation rate of the agents shows a great variation in separate publications and it is reported to be between 5.5 and 52.7% (Taşkesen and Taş, 2007;Sümer et al, 2000;Pişkin et al, 2005;Silva et al, 2010;Zimba et al, 2009;Abdulrab et al, 2010). Differences in the isolation rates may be attributed to several factors such as small number of bacteria found in CSF of meningitis cases, storage of samples in unsuitable conditions until the time of inoculation and require- ment of special growth conditions for some causative agents such as H. influenzae and N. meningititis bacteria which are difficult to grow antibiotic adminestration before sample collection.…”

“…A commercially available kit based on hybridization was used in this study which investigated DNA of the three agents most commonly detected during the study (H. influenzae, N. meningitidis and S. pneumoniae). These three agents studied are reported to be the three most frequently encountered meningitis agents (Booy and Kroll, 1994;Silva et al, 2010). S. pneumoniae and H. influenzae were detected in 10 of the samples examined.…”

“…Increases in cell count are usually excessive in the bacterial meningitis cases (>500 cell/mm 3 , whereas normal level is <10 cell/ mm 3 ) and polymorphonuclear leucocytes are dominant (Kanra et al, 2003;Özdemir et al, 2010). Despite availability of vaccination programs for bacterial meningitis, the most commonly seen causative agents in our country and worldwide include Haemophilus influenza, Neisseria meningitidis and Streptococcus pneumoniae (Silva et al, 2010;Pehlivanoglu et al, 2011). These agents are microorganisms that can be cultured by several laboratories with their available sources.…”

A Three years retrospective analysis of agents isolated from cerebrospinal fluid in a University Hospital

“…1,2 Yaş, coğrafi farklılıklar, mevsim, toplumun belirli etkenlere karşı aşılı olup olmaması, genetik yapı, sosyoekonomik koşullar gibi risk faktörlerine bağlı olarak değişmekle birlikte Dünyada ve ülkemizde en sık en sık tespit edilen etkenleri; Streptococcus pneumoniae, Neisseria meningitidis tip b ve Haemophilus influenzae'dır. [3][4][5][6] Menenjitin erken ve etkin olarak tedavi edilmesi hastalığın klinik sonuçları üzerinde olumlu etki gösterir. Tedavi edilmeyen hastalarda kafa içi basınç artışına bağlı gelişen komplikasyonlar, sepsis ve çoklu organ yetmezlikleri nedeniyle yüksek mortalite veya kalıcı nörolojik fonksiyon kayıpları görülür.…”