Detection of Acute Childhood Meningitis by PCR, Culture and Agglutination Tests in Tabriz, Iran
Meningitis is one of the hazardous and life threatening infections and is associated with mortality and morbidity. The aim of this study was to determine etiological agents of childhood bacterial meningitis. The culture, Gram staining, agglutination and PCR assays were used to examine CSF specimens from 277 patients with presumed bacterial meningitis for the occurrence of 4 most common infectious agents consist of N. meningitis, H. influnsae, S. pneumoniae and S. agalactiae between 2008 and 2009 at different wards of the Children Hospital of Tabriz. The mean age of patients was 35±2 (Mean±SEM) month, (minimum 11 days maximum14 years), of all cases 59.6% male and 40.4% female. Overall the diagnosis was confirmed with a CSF culture in 11/277 (3.97%), by agglutination test in 14/277 (5.05%). The isolated bacteria included S. pneumoniae 5 cases, H. influnsae 2 cases, N. meningitis 3 cases and P. aeroginusae 1 case. A positive PCR assay allowed us to diagnose bacterial meningitis in 19 patients (6.8%). In the present study, we found PCR to be a useful and sensitive method for the detection of bacterial DNA in the CSF samples from suspected meningitis patients. Furthermore, to maximize management of meningitis cases, a combination of culture and PCR is necessary.
Balganesh M, Lalitha MK, Nathaniel R.Rapid diagnosis of, acute pyogenic meningitis by a combined PCR dot-blot assay.Mol Cell Probes 2000;14(2):61-9.
Corless CE, Guiver M, Borrow R, Edwards-Jones V, Fox AJ, Kaczmarski EB.Simultaneous detection of Neisseria meningitidis, Haemophilusinfluenzae, and Streptococcus pneumoniae in suspected cases of meningitis and septicemia using real-time PCR.J ClinMicrobiol2001;39(4):1553-8.
Saravolatz LD, Manzor O, VanderVelde N, Pawlak J, Belian B.Broad-range bacterial polymerase chain reaction for early detection of bacterial meningitis.Clin Infect Dis 2003;36(1):40-5.
Schuurman T, de Boer RF, Kooistra-Smid AM, van Zwet AA.Prospective study of use of PCR amplification and sequencing of 16S ribosomal DNA from cerebrospinal fluid for diagnosis of bacterial meningitis in a clinical setting. J ClinMicrobiol2004;42(2):734-40.
Marandi FR, Rahbar M, Sabourian R, Saremi M.Evaluation of Iranian microbiology laboratories for identification of etiologic agents of bacterial meningitidis. Survey results of an external quality assessment scheme (EQAS) programme. J Pak Med Assoc2010;60(1):48-51.
Carrol ED, Thomson AP, Shears P, Gray SJ, Kaczmarski EB, Hart CA.Performance characteristics of the polymerase chain reaction assay to confirm clinical meningococcal disease. Arch Dis Child 2000;83(3):271-3.
Nakhjavani FA, BonakdarHashemi F, Kalani MT, Kazemi B, Nouri K, Azadi N, HaghiAshtiani M. Detection of Haemophilusinflunsae type b in CSF of suspected children with meningitis by PCR. Med J Islamic Rep Iran 2005;19(2):181-183.
Davison KL, Ramsay ME.The epidemiology of acute meningitis in children in England and Wales. Arch Dis Child 2003;88(8):662-4.
Pollard AJ, Probe G, Trombley C, Castell A, Whitehead S, Bigham JM, Champagne S, Isaac-Renton J, Tan R, Guiver M, Borrow R, Speert DP, Thomas E.Evaluation of a diagnostic polymerase chain reaction assay for Neisseria meningitidis in North America and field experience during an outbreak. Arch Pathol Lab Med 2002;126(10):1209-15.
Alborzi A, Vahedi F, Karimi A, Azmoodeh M, Labaf R, Kadivar MR, Aboodi B. Bacterial etiology of acute childhood meningitis in Shiraz Iran: incidence clinical pictures, complication and antibiotic sensitivity pattern.Iran J Infect Dis Trop Med 2002;7(18):26-31.
Mehrabi-Tavana A, Ataee RA. Meningococcal meningitis control in Iran: five year comparative study 2000-2004. J Med Sci 2009;9(1):51-4.
Tsolia MN, Theodoridou M, Tzanakaki G, Kalabalikis P, Urani E, Mostrou G, Pangalis A, Zafiropoulou A, Kassiou C, Kafetzis DA, Blackwell CC, Kremastinou J, Karpathios TE.The evolving epidemiology of invasive meningococcal disease: a two-year prospective, population-based study in children in the area of Athens. FEMS Immunol Med Microbiol2003;36(1-2):87-94.
Ceyhan M, Yildirim I, Balmer P, Borrow R, Dikici B, Turgut M, Kurt N, Aydogan A, Ecevit C, Anlar Y, Gulumser O, Tanir G, Salman N, Gurler N, Hatipoglu N, et al. A prospective study of etiology of childhood acute bacterial meningitis, Turkey.Emerg Infect Dis 2008;14(7):1089-96.
Grimwood K, Anderson P, Anderson V, Tan L, Nolan T.Twelve year outcomes following bacterial meningitis: further evidence for persisting effects. Arch Dis Child 2000;83(2):111-6.
Bahador MO, Amini M, Bahador MA. Common cause and cerebrospinal fluid changes of acute bacterial meningitis. Iran J Pathol 2009;4(2):75-9.
YousefiMashouf R, Hashemi SH, Bijarchi M. Bacterial agents of meningitis in children and detection of their antibiotic resistance patterns in Hamadan, Western Iran. Pak J Bio Sci 2006;9(7):1293-8.
Klinger G, Chin CN, Beyene J, Perlman M.Predicting the outcome of neonatal bacterial meningitis. Pediatrics 2000;106(3):477-82.
Ghotaslou R, Ghorashi Z, Nahaei MR.Klebsiellapneumoniae in neonatal sepsis: a 3-yearstudy in the pediatric hospital of Tabriz, Iran.Jpn J Infect Dis. 2007;60(2-3):126-8.
Tiskumara R, Fakharee SH, Liu CQ, Nuntnarumit P, Lui KM, Hammoud M, Lee JK, Chow CB, Shenoi A, Halliday R, Isaacs D; Asia-Pacific Neonatal Infections Study.Neonatal infections in Asia.Arch Dis Child Fetal Neonatal Ed 2009;94(2):F144-8.
Zaidi AK, Thaver D, Ali SA, Khan TA.Pathogens associated with sepsis in newborns and young infants in developing countries.Pediatr Infect Dis J 2009;28(1 Suppl):S10-8.
Aletayeb MH, Ahmad FS, Masood D.Eleven-year study of causes of neonatal bacterial meningitis in Ahvaz, Iran.PediatrInt2010;52(3):463-6.