Epidemiological study of acute bacterial meningitis in admitted children below twelve years of age in a tertiary care teaching hospital in Pune, India

Debnath, Dhrubajyoti J; Wanjpe, Arun; Kakrani, Vandana; Singru, Samir A

doi:10.4103/0975-2870.97508

Cited by 12 publications

(18 citation statements)

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“…The male to female ratio among confirmed meningitis cases in the present study was 1.3:1 and the difference was not statistically significant (p = 0.625). Similar male preponderance has been reported in studies from Pune and Pondicherry wherein the male/female ratio was observed to be 1.8:1 and 1.4:1, respectively [ 19 , 20 ]. It is a common societal practice in many communities in India that a male child gets preferential care [ 21 ].…”

Section: Discussionsupporting

confidence: 85%

“…In the present study, maximum number of cases were seen in children aged between one and 11 months accounting for 55.3% of all positive cases. High rates of bacterial meningitis in children of the same age group have also been reported in other Indian studies [ 18 , 19 ]. Under-developed immune system in these very young children could possibly be making them more susceptible to bacterial meningitis [ 18 ].…”

Section: Discussionsupporting

confidence: 78%

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Burden of bacterial meningitis in India: Preliminary data from a hospital based sentinel surveillance network

et al. 2018

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BackgroundWorldwide, acute bacterial meningitis is a major cause of high morbidity and mortality among under five children, particularly in settings where vaccination for H. influenzae type b, S. pneumoniae and N. meningitidis is yet to be introduced in the national immunization programs. Estimation of disease burden of bacterial meningitis associated with these pathogens can guide the policy makers to consider inclusion of these newer vaccines in the immunization programs. A network of hospital based sentinel surveillance was established to generate baseline data on the burden of bacterial meningitis among children aged less than 5 years in India and to provide a platform for impact assessment following introduction of the Pentavalent and Pneumococcal Conjugate Vaccines (PCV).MethodsDuring surveillance carried out in select hospitals across India in 2012–2013, information regarding demographics, immunization history, clinical history, treatment details and laboratory investigations viz. CSF biochemistry, culture, latex agglutination and PCR was collected from children aged 1 to 59 months admitted with suspected bacterial meningitis.ResultsA total of 3104 suspected meningitis cases were enrolled from 19,670 children admitted with fever at the surveillance hospitals. Of these, 257 cases were confirmed as cases of meningitis. They were due to S. pneumoniae (82.9%), H. influenzae type b (14.4%) and N. meningitidis (2.7%). Highest prevalence (55.3%) was observed among children 1 to 11 months. Antimicrobial susceptibility testing revealed considerable resistance among S. pneumoniae isolates against commonly used antibiotics such as cotrimoxazole, erythromycin, penicillin, and cefotaxime. More commonly prevalent serotypes of S. pneumoniae in circulation included 6B, 14, 6A and 19F. More than 90% of serotypes identified were covered by Pneumococcal Conjugate Vaccine 13.ConclusionsWe observed that S. pneumoniae was the commonest cause of bacterial meningitis in hospitalized children under five years of age in India. Continued surveillance is expected to provide valuable information and trends in future, to take an informed decision on introduction of pneumococcal vaccination in Universal Immunization Programme in India and will also eventually help in post-vaccination impact evaluation.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 78%

Burden of bacterial meningitis in India: Preliminary data from a hospital based sentinel surveillance network

et al. 2018

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“…2,[15][16][17] Males outnumbered the females by a ratio of 2:1 indicating male preponderance of ABM in our study in accordance with other studies. 12,14,18 Relative resistances to infection in females is related to certain factors regulating the synthesis of gamma globulin on X chromosome, thus explaining the preponderance for meningitis and septicemia amongst males. 19,20 Although GBS is a common cause of ABM in neonates, but it can also infect children in postneonatal period.…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and outcome of pediatric bacterial meningitis: a prospective study from tertiary institute in Northern India

Garg

Sharma

Kumari³

et al. 2018

Int J Res Med Sci

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Background: Meningitis is one of the fatal infections occurring in infants and older children. In acute bacterial meningitis (ABM), inflammation of the leptomeninges is triggered by bacteria present in the subarachnoid space. ABM is associated with a high rate of acute complications and long-term morbidity. Aim of our study was to determine the incidence, etiological profile and complications of acute bacterial meningitis amongst children belonging to one month to five years of age.Methods: The present study was conducted over a period of one year and diagnosis of meningitis was made on basis of history, examination and laboratory investigations. Clinical features were recorded on case sheet. Lumbar puncture was done, and CSF was sent for biochemical analysis, cell counts, staining, culture and latex agglutination test (LAT).Results: Out of total 1560 admitted cases (1 month to 5years age group), 160 cases were suspected with meningitis while 57 cases were confirmed to have ABM. Most (59.6%) cases belonged to 3 months to 1-year age group and males outnumbered the females by a ratio of 2:1. Group B Streptococcus (45.6%) was most common pathogen in 45.6% cases followed by Streptococcus pneumoniae (21%) and Hemophilus influenzae (10.52%). Seizures (45%) and increased ICP (28%) were main acute complications observed during hospitalization while hemiparesis 9.6%, monoparesis 4.8%, seizures 38%, vision and hearing deficits were the sequelae observed on follow up examination. These complications were predominantly contributed by S. pneumoniae and H. Influenzae.Conclusions: The incidence of ABM is still high and Group B streptococcus is main pathogen even in post neonatal period. The complications of ABM are markedly higher in cases of S. pneumoniae, H. Influenzae meningitis in comparison to Group B streptococcus meningitis. Formulating standard protocols for management of ABM and rational antibiotic use to prevent resistance is the need of hour.

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“…The rank order of organisms detected by SES is in concordance with previously reported organisms in India. [829303132333435] Although multiplex PCR-based diagnostics have been used in CNS infections before, they are mostly confined to the detection of single or very limited families of viruses. [1836] SES, unlike other multiplex systems available, detects a variety of organisms such as viruses, bacteria, and fungi in a single assay.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of multiplex polymerase chain reaction-based molecular diagnostics (SES) in 70 patients with suspected central nervous system infections: A single-center study

Ramalingam¹,

Chakraborty²

2016

Ann Indian Acad Neurol

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Background:Central nervous system (CNS) infections present a grave health care challenge due to high morbidity and mortality. Clinical findings and conventional laboratory assessments are not sufficiently distinct for specific etiologic diagnosis. Identification of pathogens is a key to appropriate therapy.Aim:In this retrospective observational study, we evaluated the efficacy and clinical utility of syndrome evaluation system (SES) for diagnosing clinically suspected CNS infections.Materials and Methods:This retrospective analysis included inpatients in our tertiary level neurointensive care unit (NICU) and ward from February 2010 to December 2013. Cerebrospinal fluid (CSF) samples of 70 patients, clinically suspected of having CNS infections, were subjected to routine laboratory tests, culture, imaging, and SES. We analyzed the efficacy of SES in the diagnosis of CNS infections and its utility in therapeutic decision-making.Results:SES had a clinical sensitivity of 57.4% and clinical specificity of 95.6%. Streptococcus pneumoniae and Pseudomonas aeruginosa were the top two bacterial pathogens, whereas Herpes simplex virus (HSV) was the most common viral pathogen. Polymicrobial infections were detected in 32.14% of SES-positive cases. SES elicited a change in the management in 30% of the patients from initial empiric therapy. At discharge, 51 patients recovered fully while 11 patients had partial recovery. Three-month follow-up showed only six patients to have neurological deficits.Conclusion:In a tertiary care center, etiological microbial diagnosis is central to appropriate therapy and outcomes. Sensitive and accurate multiplex molecular diagnostics play a critical role in not only identifying the causative pathogen but also in helping clinicians to institute appropriate therapy, reduce overuse of antimicrobials, and ensure superior clinical outcomes.

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Epidemiological study of acute bacterial meningitis in admitted children below twelve years of age in a tertiary care teaching hospital in Pune, India

Cited by 12 publications

References 0 publications

Burden of bacterial meningitis in India: Preliminary data from a hospital based sentinel surveillance network

Burden of bacterial meningitis in India: Preliminary data from a hospital based sentinel surveillance network

Clinical profile and outcome of pediatric bacterial meningitis: a prospective study from tertiary institute in Northern India

Retrospective analysis of multiplex polymerase chain reaction-based molecular diagnostics (SES) in 70 patients with suspected central nervous system infections: A single-center study

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