Meningococcal Meningitis: A Multicentric Hospital-based Study in Kathmandu, Nepal

Abstract

Background:The global epidemiology of meningococcal disease varies markedly by region and over time. In Nepal, information on serogroup of meningococci is not available since the 1983 serogroup A epidemic in Kathmandu. Objective:To provide some fundamental data on the circulating serogroups of meningococci for potential meningococcal immunization programs in Nepal. Methods:This cross-sectional prospective study was conducted from January 2017 to December 2018 among 387 clinically suspected meningitis cases. Cerebrospinal fluid samples were collected by lumbar puncture technique at five referral hospitals of Kathmandu and processed by conventional cultural techniques. Neisseria meningitidis was identified by colony morphology, Gram staining and oxidase test. Serogrouping of meningococci was performed by slide agglutination test. Antibiotic susceptibility testing was done by the modified Kirby Bauer disc diffusion method. The data was entered into IBM SPSS Statistics 21 software and a p-value of <0.05 was considered significant. Results:Thirty-two samples were positive by culture for a bacterial pathogen with 2.3% of meningococci. All except one meningococcal meningitis cases were aged below 15 years. All N.meningitidis isolates belonged to serogroup A and were susceptible to ceftriaxone, chloramphenicol, meropenem and minocycline; however, 22% isolates showed resistance to cotrimoxazole and 11% intermediate resistance to ciprofloxacin. Conclusion:The circulating serogroup of N. meningitidis in Kathmandu has not changed over the past 35 years. The prevalence of meningococcal meningitis in Kathmandu is low but might be underestimated due to the sole use of culture-based diagnostic methods. Detection of meningococci by alternative methods may be useful in the precise estimation of actual disease burden.

Detection of Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae in Culture Negative Cerebrospinal Fluid Samples from Meningitis Patients Using a Multiplex Polymerase Chain Reaction in Nepal

“…Such a limitation could be overcome by the molecular approach. In our previous multicentric hospital-based study on bacterial meningitis which was based on conventional culture techniques, there was low culture yield of CSF [ 12 ]. To improve the diagnosis of bacterial meningitis in culture negative CSF samples, we employed multiplex PCR for the detection of S. pneumoniae , N. meningitidis and H. influenzae in the CSF sample.…”

“…The CSF sample was collected by the attending physician/medical officer by lumbar puncture (LP) from each clinically suspected meningitis case at the respective study site. A sterile wide bore needle was inserted between the lumbar vertebrae L4 and L5 and the CSF sample was allowed to drip into the sterile container [ 12 ].Altogether 387 CSF samples were processed for culture immediately after collection and stored at −80 °C. As we aimed to compare the detection of N. meningitidis , S. pneumoniae and H. influenzae in CSF by two methods, three samples positive for E. coli were excluded in this study.…”

Meningococcal Carriage among Household Contacts of Patients with Invasive Meningococcal Disease in Kathmandu, Nepal: A Longitudinal Study

“…This longitudinal study was conducted from January 2017 to December 2019 among household contacts of laboratory-confirmed meningococcal meningitis cases. Five study sites within the Kathmandu Valley of Nepal were selected, which was due to the identification of meningococcal meningitis cases during our previous cross-sectional, multicentric, hospital-based study [ 37 ].…”

“…Serogrouping of N. meningitides isolate was done through slide agglutination testing using group-specific antisera (Remel Europe, Ltd., Dartford, UK) for serogroups A, B, C, W and Y, as described previously [ 37 ].…”