Epidemiology of Aseptic Meningitis in Infants and Children (Shiraz - Iran)

Sasan, Mohammad Saeed; Alborzi, Abdolvahab; Ziyaeyan, Mazyar

doi:10.5812/archcid.15086

Cited by 12 publications

(11 citation statements)

References 8 publications

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“…Moreover, the most predominant age group unprotected against meningitis is children under the age of 5. Our finding is affirmed by the results of the published works in various geographic regions of Iran [27–29]. However, an observational study in England and Wales noted that Neisseria meningitidis was a leading pathogen of bacterial meningitis, followed by Streptococcus pneumoniae [30].…”

Section: Discussionsupporting

confidence: 82%

Epidemiological profile of meningitis in Iran before pentavalent vaccine introduction

et al. 2019

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BackgroundNo reliable and comprehensive study has been published on the incidence and epidemiological profile of meningitis in Iran from 2008 to 2014, before pneumococcal conjugate vaccine (PCV) and pentavalent vaccine (DTPw-Hep B-Hib (PRP-T) vaccine (pentavac) (adsorbed)) introduction. The present study aimed to portray the epidemiological profile of meningitis in Iran from 2008 to 2014.MethodsData on meningitis cases aged from 1 day to 110 years were extracted from national notifiable diseases surveillance system from March 2008 to December 2014 in Iran. A total number of 48,006 cases of suspected meningitis were identified and 1468 cases of which met the criteria for diagnosis-confirmed meningitis. Of 1468 cases, 1352 patients were included in the study.ResultsThe great number of cases reported from urban areas. Moreover, males were more predominant than females (58.51% vs. 33.81%) in total. The estimated annual incidence rate of meningitis varied from 0.28/100000 in 2008 to 0.09/100000 in 2014. Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis were the most leading pathogens causing bacterial meningitis, accounted for 266(23.44%), 145(12.78%), 95(8.37%) of cases, respectively. Each of the three bacterial species showed a descending trend. The majority of infected subjects are children under five years.ConclusionsUnlike the decreasing trend of meningitis and high percentage of cultures with negative results, according to World Health Organization recommendation PCV introduction into routine immunization is evident. Implementing an enhanced surveillance system to provide high quality data on epidemiological profile of meningitis in Iran is necessary.

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Section: Discussionsupporting

confidence: 82%

Epidemiological profile of meningitis in Iran before pentavalent vaccine introduction

et al. 2019

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“…The rate of BM was 6.9% and 4.5% in Mashhad and Shiraz, respectively, in (non-neonates) children who underwent LP with suspicion of meningitis, yet among children with confirmed meningitis (who had CSF pleocytosis) this rate was 16.3% and 12.3%. The rate of normal CSFs in children (not neonates) suspected of meningitis was 33.4% in this study, yet in Mashhad and Shiraz this was reported as 57.4% and 63.6%; the possible causes of this large mismatch can be neglect of reserving normal CSFs for further analysis or an unusual Enterovirus season in the current study ( 5 , 6 ).…”

Section: Discussioncontrasting

confidence: 57%

Enteroviral Meningitis in Neonates and Children of Mashhad, Iran

Vahedian-Shahroodi

Ghazvini

Sadeghi

et al. 2016

Jundishapur J Microbiol

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BackgroundThe highest incidence of meningitis occurs during the neonatal period and (then) infancy. Although Bacterial agents are the most dangerous cause of neonatal and childhood meningitis yet viruses especially, enteroviruses (EV), are by far the most common cause of meningitis in this age group.ObjectivesThe aim of the current study was to evaluate the role of EVs in neonatal and childhood meningitis in the Mashhad city of Iran.Materials and MethodsThis was a descriptive study that was performed at Imam Reza hospital in a period of six months (March to September 2007), during which all of the cerebral spinal fluid (CSF) samples from the neonatal intensive care unit (NICU) and pediatrics ward were collected and real time-polymerase chain reaction (RT-PCR) for EVs was done on these samples. Clinical data were collected retrospectively from hospital files.ResultsWe collected 58 CSF samples (35 neonates and 23 children) during six months. Pleocytosis of CSF was seen in 51.1% of the subjects (28% of neonates, and 66.6% of infants and children). Enteroviruses PCR was positive in 37.1% (13) of neonates and 34.7% (8) of children. Pleocytosis of CSF was seen in 23% and 75% of EV positive neonates and children, respectively. Polymorphonuclear (PMN) dominance (PMN > 50%) of CSF was seen in 50% and 33% of EV positive neonates and children, respectively. There were three cases of bacterial meningitis in our group; EV PCR result was positive for one of these subjects. Concomitant bacterial infection (meningitis and sepsis) was seen in 9.5% (two cases) of EV positive CSFs in our study. Almost half of the available neonates (four of nine) with pure enteroviral meningitis (EVM) were discharged (in good condition) with final diagnosis of culture negative sepsis (CNS) and mean length of hospital stay (MLOS) of 4.3 days. One (12.5%) of the neonates with EVM, who had a very low birth weight (< 1500 mg), was expired, and two (25%) cases were discharged with brain damage and final diagnosis of severe asphyxia. The MLOS for children with pure EVM was 1.6 days (one to four days); they didn't have any sign of brain damage or mortality. Qualitative c-reactive protein (CRP) of serum was negative in 72.7% and 37.5% of EV positive neonates and children, respectively. The mean white blood cell count and PMN percentage in the peripheral blood was 11416/mm3 and 60.8% for EV positive neonates, and 14500/mm3 and 77.1% for EV positive children, respectively. Hyponatremia, due to possible syndrome of inappropriate antidiuretic hormone (SIADH), was seen in 30% of neonates and 57% of children with EVM.ConclusionsEnteroviruses were a common cause (> 30%) of meningitis in our study group. Concomitant bacterial infection is not rare in neonates and children with EVM. Many of the neonates (50%) and almost all of the children with EVM did not require prolonged hospitalization. Both normal CSF and PMN dominancy of CSF was common in neonates and children with EVM. Positive qualitative CRP of serum (up to two plus) was common especially in children with ...

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“…However, there was an increase in the WBC differential with a significant predominance of lymphocytes (P < 0.001). This data is in agreement with the fact that unlike changes in CSF from bacterial meningitis, in viral meningitis lymphocytosis may provide a clue for diagnosis, a finding similar to the results reported by another Iranian paper ( 22 ). Although in our study a small number of the samples were positive, most of these infections occurred between May and July, a timeframe similar to those given in other reports indicating a higher occurrence of viral meningitis during spring and summer ( 22 - 24 ).…”

Section: Discussionsupporting

confidence: 92%

Study of the Frequency of Herpesvirus Infections Among Patients Suspected Aseptic Meningitis in the West of Iran

Akya

Ahmadi

Zehtabian

et al. 2015

Jundishapur J Microbiol

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Background:Aseptic meningitis is the most common type of meningitis and is characterized by meningeal inflammation that is not linked to identifiable bacterial pathogens in cerebrospinal fluid (CSF).Objectives:This study aimed to evaluate the frequency of aseptic meningitis caused by herpesviruses, namely herpes simplex types I and II (HSV-1, HSV-2), Epstein-Barr virus (EBV), cytomegalovirus (CMV) and varicella-zoster virus (VZV).Patients and Methods:A total of 196 CSF samples were collected from patients with suspected meningitis. All samples were smear- and culture-negative for bacterial pathogens. The biochemical and cytological findings of CSF samples were also recorded. DNA was extracted from samples and PCR with specific primers was carried out to detect viruses.Results:The 196 samples derived from 100 (52%) men and 96 (48%) women ranging in age from one day to 86 years with an average age of 32.3 ± 25.3 years. Of them, 8 (4.08%) samples yielded positive results, including 5 (2.55%) cases of VZV infection and 3 (1.53%) cases of HSV-1 infection. No cases of HSV-2, CMV or EBV infection were detected. CSF protein and glucose levels among positive cases were all in the normal range.Conclusions:The results indicate a considerable rate of herpesvirus infection in patients with aseptic meningitis, and that VZV is the most common herpesvirus to cause infection followed by HSV-1. Our results also showed that a moderate increase in the WBC count and predominance of lymphocytes can be valuable clues in diagnosing viral meningitis. Given the different approaches of drug therapy in bacterial and viral meningitis, use of molecular methods is necessary in hospitals to rapidly discriminate between them.

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Epidemiology of Aseptic Meningitis in Infants and Children (Shiraz - Iran)

Cited by 12 publications

References 8 publications

Epidemiological profile of meningitis in Iran before pentavalent vaccine introduction

Epidemiological profile of meningitis in Iran before pentavalent vaccine introduction

Enteroviral Meningitis in Neonates and Children of Mashhad, Iran

Study of the Frequency of Herpesvirus Infections Among Patients Suspected Aseptic Meningitis in the West of Iran

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