Acute Bacterial Meningitis among Children Admitted into an Iranian Referral Children's Hospital

Abstract

SUMMARY: Bacterial meningitis is a serious threat to global health, particularly in developing countries. The aim of this study was to determine the etiological agents of acute bacterial meningitis, its clinical features, and antibacterial susceptibility among Iranian children who were admitted to a referral regional children's hospital. Laboratory data as well as symptoms and signs on admission, organism identification and antibiotic susceptibility results, physical examination findings, and neurologic features of 31 patients with suspected invasive bacterial infection were evaluated, of which 20 (64.5z) had positive cerebrospinal fluid (CSF) cultures. The microorganisms most commonly associated with bacterial meningitis in children were Streptococcus pneumoniae (7 isolates, 22.5z), Haemophilus influenzae (3 isolates, 10z), and Neisseria meningitidis (3 isolates, 10z). In our study, the rate of mortality and sequelae were 10z and 35z, respectively. Ventriculomegaly hydrocephalus was found in 1 case positive for Mycobacterium tuberculosis meningitis, while other signs of meningitis were negative. According to our results, abnormalities including brain edema, subdural effusion, microabscess, and ventriculomegaly hydrocephalus were observed in 50z of the patients with confirmed bacterial meningitis; therefore, identification of predictors of early neurological complications is highly recommended. In addition, CSF culture using the BACTEC automated system is recommended for detection of the etiologic agents of bacterial meningitis, particularly in a population like ours, in which the patients receive a course of antibiotics without prescription.

Detection of Haemophilus influenzae type b, Streptococcus agalactiae, Streptococcus pneumoniae and Neisseria meningitidis in CSF specimens of children suspicious of Meningitis in Ahvaz, Iran

“…In our study, no N. meningitidis isolate was detected, based on bacterial culture and PCR. In contrast to our results, N. meningitidis was detected among infants and children in other regions of Iran (three cases in Tabriz [8] and three cases in Tehran [12]). On the other hand, N. meningitis was the most common cause of BM among Turkish children in their first five years of life, especially in infants aged zero through six months under five years old [9].…”

“…In our study, S. pneumoniae was detected in five patients by lytA primers and only one patient by ply primers. Similar to our study results, the frequency of this bacterium in CSF samples of children suspected of having BM in other regions of Iran was reported, and was 1.8% (5 of 277) in Tabriz [18] and 22.5% (7 of 31) in Tehran [12]. The ongoing development of the pneumococcal vaccine for routine immunization schedules in most countries has remarkably reduced the frequency of invasive diseases caused by vaccine serotypes [26].…”

“…The distribution of BM among infants and children in Iran is at variable frequencies of 2.9–64.5% [11,12]. In Iran, the statistical records show that, after Hib, S. pneumoniae is the most common cause of BM in children under 5 years old [10].…”

Epidemiology of Meningitis Studied at a University Hospital in Zahedan, South-Eastern Iran

“…Risk factors for meningitis include: skipping vaccinations, age (most cases of viral meningitis occur in children younger than five years old and bacterial meningitis commonly affects people under 20), living in a community setting (college students living in dormitories, personnel on military bas-es, and children in boarding schools and child care facilities are at increased risk of meningococcal meningitis), and factors that may compromise patients' immune system including; AIDS, use of immunosuppressant drugs, and removal of the spleen (3-6). There are many reports about the epidemiology of meningitis and according to the community under study, age of cases and other risk factors, agents and clinical outcome are different (8)(9)(10)(11)(12)(13)(14)(15)(16)). …”

Prevalence of Etiological Agents and Antimicrobial Resistance Patterns of Bacterial Meningitis in Nemazee Hospital, Shiraz, Iran

“…Bacterial meningitis approximately causes more than one hundred thousand deaths per year worldwide (2). Meningitis continues to remain among the leading causes of childhood death, particularly in the developing countries (3). Nowadays in spite of the great improvement in modern antibiotics and healthcare services, the life-threatening problem of bacterial meningitis is not eliminated (4).…”