Detection, Antimicrobial Susceptibility and Serotyping of <i>Streptococcus pneumoniae</i> from Cerebrospinal Fluid Specimens from Suspected Meningitis Patients

Abstract

Pneumococcal meningitis is the most important cause of community-acquired meningitis in children resulting in high morbidity and mortality worldwide. This study aimed to evaluate immunochromatographic test (ICT), a rapid detection method, for pneumococci in cerebrospinal fluid (CSF) and also to assess antibiotic susceptibility pattern of the clinical isolates. The findings of CSF-ICT of suspected meningitis cases were also compared with the results of CSF culture, latex agglutination test (LAT) and polymerase chain reaction (PCR). Among these diagnostic methods, ICT and PCR showed 100% specificity. A total of 401 CSF specimens were cultured but culture positivity was observed with 55 (13.7%) cases in which Streptococcus pneumoniae was identified from 20 (36.4%) culture-positive cases. A remarkably high resistance rate to gentamicin (95%) and cotrimoxazole (60%) among the invasive strains of S. pneumoniae was observed, while none of the isolates exhibited resistance to penicillin, ceftriaxone and chloramphenicol by disk diffusion test. Minimum inhibitory concentration (MIC) showed similar susceptibility pattern. The invasive strains (n = 18) belonged to 9 different serotypes including 1, 2, 4, 34, 12A, 38, 19F, 35A and 45. The prevalent serotypes were 2 (23.5%), 1 (17.6%) and 45 (11.8%). The study shows that a remarkable proportion of meningitis cases in children are caused by S. pneumoniae. Diagnostic methods like ICT and PCR can be considered as effective methods for the detection of pneumococcal meningitis even with the patients who have been treated with empirical antibiotics. Ceftriaxone is a safe choice for empirical therapy, while the use of cotrimoxazole for the treatment of meningitis infections is debatable. Keywords: Pyogenic meningitis, Cerebrospinal fluid (CSF), Streptococcus pneumoniae Immunochromatographic test (ICT), Polymerase chain reaction (PCR), SerotyingDOI: http://dx.doi.org/10.3329/bjm.v24i1.1232 Bangladesh J Microbiol, Volume 24, Number 1, June 2007, pp 24-29

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

“…Antibiotic susceptibility patterns may also vary among hospitals; therefore, this information is particularly vital for the effectiveness of empirical therapy in acute cases (7,9). Neisseria meningitides, Streptococcus pneumonia, and Haemophilus influenzae type b are most commonly associated with bacterial meningitis (5). However, the relative prevalence of the reported bacterial meningitis isolates vary with age and geographical regions (10).…”

“…Gram staining is widely available and as an inexpensive and rapid procedure is routinely performed for primary diagnosis of bacterial meningitis (6). However, gram staining sensitivity is not totally reliable, so CSF culture is mandatory to diagnose bacterial meningitis (5,6). Implementation of rational antimicrobial therapy based on the findings of early CSF examination has an important role in limitation of bacterial meningitis and also its future outbreaks (5).…”

“…However, gram staining sensitivity is not totally reliable, so CSF culture is mandatory to diagnose bacterial meningitis (5,6). Implementation of rational antimicrobial therapy based on the findings of early CSF examination has an important role in limitation of bacterial meningitis and also its future outbreaks (5). Bac-terial meningitis often presents nonspecific signs and symptoms, especially in neonates; therefore, empirical antimicrobial therapy should be initiated based on low clinical suspicion until CSF culture results would be prepared (1).…”

“…Prolonged persistence of infection in the Cerebrospinal Fluid (CSF) may result in quite severe neurological damages as well as mortality, if rapid measures are not taken (4). Rapid identification and immediate treatment of meningitis causative agent is necessary because of its potential devastating effects (5). Gram staining is widely available and as an inexpensive and rapid procedure is routinely performed for primary diagnosis of bacterial meningitis (6).…”

Antimicrobial susceptibility pattern and serotyping of <i>Streptococcus pneumoniae</i> isolated from Kanti Children Hospital in Nepal

“…Apart from epidemic, at least 1. 2 million cases of meningitis are estimated to occur every year with 135, 000 deaths 9 .…”