The rise and fall of epidemic Neisseria meningitidis from a tertiary care hospital in Delhi, January 2005–June 2007

Abstract

Meningococcal meningitis is endemic in India. There has been a sudden surge of cases of meningococcal meningitis in 2005 in Delhi. Present study was undertaken to find out changing trends in incidence of this disease from a tertiary care hospital in New Delhi over a period of two and half years. All samples from suspected cases of meningococcal meningitis were subjected to Gram staining, culture and latex agglutination test for detection of Neisseria meningitidis (N.meningitidis). Antimicrobial susceptibility of all isolates was performed using the disc diffusion test. 78.6%, 71.4% and 100% of the samples were positive for N.meningitidis by smear examination, culture and latex agglutination test respectively. Except for resistance to Penicillin and Erythromycin in 8.8% and 5.9%, the isolates were sensitive to the commonly used antibiotics. Using simple, rapid and reliable methods for diagnosis, defining risk factors and continuing surveillance remain important public health goals for the control of meningococcal disease.

A Comprehensive Review of Meningococcal Disease Burden in India

“…Similar results of decreased antibiotic sensitivity were reported in four surveillance studies in endemic settings for amoxicillin, ampicillin, erythromycin and penicillins [28,36,40,49].…”

“…These 32 publications reported data on meningococcal disease from different regions of India: Delhi ( n = 11) [ 16 , 24 – 26 , 34 , 40 , 45 – 47 , 52 , 53 ], Karnataka ( n = 5) [ 36 , 43 , 44 , 49 , 50 ], Assam ( n = 3) [ 28 , 32 , 33 ], Kashmir ( n = 2) [ 27 , 41 ], Chandigarh ( n = 2) [ 37 , 51 ], Meghalaya ( n = 2) [ 30 , 31 ], multiple states ( n = 2) [ 38 , 39 ], Maharashtra ( n = 1) [ 29 ], Uttar Pradesh ( n = 1) [ 23 ], Odisha ( n = 1) [ 48 ], Tripura ( n = 1) [ 42 ] and Tamil Nadu ( n = 1) [ 35 ] (Table 2 ).…”

“…), pediatric, adolescent, adult 50% sensitivity to penicillin G, amoxicillin-clavulanic acid, amikacin, ciprofloxacin, ceftriaxone, cefotaxime, ceftazidime, Imipenem Fitzwater et al 2013 [ 35 ] Hospital-based (pediatric hospital), prospective January 2008–September 2011 NR Tamil Nadu 2564 suspected cases of meningitis Pediatric NR Gangane and Kumar 2013 [ 36 ] Hospital-based (tertiary care center), prospective November 2010–December 2012 NR Karnataka 308 CSF samples from clinical cases of bacterial meningitis (including 82 with aerobic bacterial growth) Neonate (? ), pediatric, adolescent, adult 50% sensitivity to ampicillin, gentamicin, amikacin Shameem et al 2008 [ 49 ] Hospital-based (tertiary care center), prospective February 2003–January 2007 NR Karnataka 535 suspected cases of pyogenic meningitis Pediatric Tetracyclin, Amoxicillin Kumar et al 2008 [ 40 ] Hospital-based (tertiary care center), prospective January 2005–June 2007 NR Delhi 34 samples from suspected cases of meningococcal meningitis Neonates (? ), pediatric, adolescent, adult 8.8% resistance to penicillin, 5.9% to erythromycin and intermediate sensitivity to erythromycin (11.8%) Mani et al 2007 [ 43 ] Hospital-based (tertiary care center), retrospective January 1996–December 2005 NR Karnataka 385 suspected cases of community acquired acute bacterial meningitis Pediatric, adult NR Shivaprakash et al 2004 [ ...…”

“…(n = 18) [28,29,32,35,36,38,43,[49][50][51] of suspected cases, and in one publication from Delhi, 71.4-100% (n = 34) of the samples were positive for N.meningitidis, depending on the technique used for diagnosis [40]. Mortality was not reported in any of these publications ( Table 2).…”

Hospital-based Meningococcal Disease Epidemiology over 2006-2010 in Delhi, India

“…45,[52][53][54][55][56][57][58] Owing to intensity of the symptoms of the meningococcal disease, the cases reach to the nearby hospitals but it may not be always true because of limited access and affordability of health care to people from impoverished population. Hence, the reported burden of morbidity and mortality due to meningococcal disease in Delhi may not be comprehensive.…”