Prevalence, Aetiological Agents, and Antimicrobial Sensitivity Pattern of Bacterial Meningitis Among Children Receiving Care at KCMC Referral Hospital in Tanzania

Abstract

Background: Bacterial meningitis is an inflammation of the meninges that occurs in response to bacteria, causing a significant number of morbidity and mortality worldwide, especially in newborns and people living in low-income countries. Diagnosis of bacterial meningitis combines a high index of clinical suspicion and laboratory confirmation through cerebrospinal fluid (CSF) analysis. Despite antibiotic treatment, mortality remains high and many children end with longterm consequences, which include neurological deficits, hearing loss, and cognitive impairment.Objective: To determine prevalence, aetiological agents, and antimicrobial sensitivity pattern among children aged less than 13 years with bacterial meningitis at Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania.Methods: This was a hospital-based cross-sectional study carried out in the KCMC paediatric ward . In total, 161 children aged less than 13 years suspected of having meningitis were consecutively recruited. Each child submitted to a lumber puncture and CSF collected for microscopy, cultures, antimicrobial sensitivity testing, a latex agglutination test, and a polymerase chain reaction (PCR) test. PCR was run on 129 of the selected CSF samples. Data were collected using structured questionnaires and laboratory data sheet. Aetiological agents were identified, and antibiotic sensitivity was tested. Analyses were performed using SPSS version 20.0.Results: Overall, 24 children had confirmation of having acute bacterial meningitis. Of the 161 participants, Gram stain and culture identified 4 (2.5%) children; whereas, of the 129 samples tested using the PCR, infection was confirmed in 24 (18.6%) children. Escherichia coli (n=18) was the most common organism isolated followed by Listeria monocytogenes (n=3), Streptococcus pneumonia (n=1), Group B Streptococcus (n=1), and Klebsiella species (spp.) (n=1). With the exception of Klebsiella spp., the isolated organisms were sensitive to the following commonly used antibiotics: ampicillin, chloramphenicol, gentamycin, and cephalosporin.Conclusion: PCR yielded more organisms. E. coli was the most common organism and was sensitive to the empirically used antibiotics for treatment of bacterial meningitis tested in our study.

Association of Diabetes with Meningitis Infection Risks: A Systematic Review and Meta-Analysis

“…To ensure inherent paper quality appraisal, a 12-point scoring system based on the Downs and Black checklist was adapted for the current study [35,36]. Typically, these twelve items include the following: (1) if the research was clear about its objectives/aims/hypothesis, (2) if the research was clear about the study design it used, (3) if the study participants were representative, (4) whether the fnal recruits for the study were representative of the initial population (after some participants declined to participate), (5) if the study had a good sample size, (6) if the research stated incidence of missing data and how it was managed, (7) if the sociodemographic of participants were clearly stated, (8) if the association was quantifed, it controlled for confounders (9), whether the research very clear about the results it reported, (10) if the study was explicit about how the variable of interest was measured (diabetes and meningitis), (11) the study reported any potential cases of biases or acknowledged limitations if it existed, and (12) if the outcome of interest for the research was explicitly stated. Other items known to be associated with quality such as inclusion and exclusion criteria for recruiting eligible study subjects, were assessed.…”

“…Tis incident rate could be 10 times higher in resource-poor settings such as sub-Saharan Africa (SSA) and poorer countries in Asia [10]. For example, a study conducted in Tanzania reported a bacterial meningitis prevalence of 18.6% [11]. Typically, cryptococcal meningitis which is fungal-based has been discovered as the most prevalent among people living with HIV (PLHIV).…”

Prevalence and outcome of bacterial meningitis among children of less than 10 years along the Kilombero valley in Morogoro, Tanzania

“…The associated clinical signs of bacterial meningitis include apnoea, fever, hypothermia, lethargy, seizures, bulging fontanel, nuchal rigidity, nausea, vomiting, coma, etc. However, the patient's age influences the clinical presentation of bacterial meningitis [9,10]. The diagnosis of the disease is generally a challenge in most health facilities because of the insufficient resources such as practitioners who can perform a lumbar puncture, appropriate equipment and access to microbiology; furthermore, bacterial meningitis causes fever.…”

“…As a result, patients suffer from the long term sequelae of the disease [7,8,10]. A study done in Tanzania on bacterial meningitis has reported a prevalence of 18.6% [9]. This calls for the improvement of the diagnostic facilities for early and effective diagnosis as well as early treatment to cater for risk factors for mortality in children under the age of ten years.…”

“…In addition, most cases of meningitis might go unreported due to either antibiotics prescribed without laboratory evidence, lack of sensitivity of the diagnostic techniques, or delayed presentation of cases [11,12] . Furthermore, Abdallah et al [9] described meningitis as associated with Escherichia coli, Listeria monocytogenes, Streptococcus pneumoniae, Group B Streptococcus and Klebsiella spp. Chambuso et al [12] established that meningitis is commonly caused by S. pneumoniae, Haemophilus influenzae, Group B Streptococcus, E. coli and Mycobacterium tuberculosis.…”