Etiology of Acute Bacterial Meningitis in Iran: a Systematic Review

  • Reza Ghotaslou Mail Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Fatemeh Yeganeh-Sefidan Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Behnaz Salahi-Eshlaqi Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
  • Hamed Ebrahimzadeh-Leylabadlo Department of Microbiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Acute bacterial meningitis, Etiology, Iran


Acute bacterial meningitis (ABM) is one of the most severe infectious diseases, causing neurologic sequel, and a case fatality rate of 20-30%. The aim of this paper was to summarize the main causes of ABM in Iran. We searched the data for relevant articles using meningitis, etiology, and Iran as search terms. We found 23 papers for inclusion in the review that focused specifically on the ABM, addressing etiology and acute meningitis. Finally, during the 23 years, a total of 18163 cases were recorded, and 1074 cases of which met the criteria for bacterial meningitis. The most common agent associated with bacterial meningitis was S. pneumoniae, followed by H. influenzae, Enterobacter spp., N. meningitidis, and group B streptococcus. The total incidence of ABM during 1991 to 2002 was higher than during 2003-2013. S. pneumoniae still remains a main cause of bacterial meningitis. For improved outcomes, studies are needed to further clarify the etiology of meningitis in Iran, explore simple, accurate, and practical diagnostic tools as PCR, and investigate the most appropriate specific and supportive interventions to manage and prevent meningitis as vaccination.


Prasad K, Karlupia N. Prevention of bacterial meningitis: an overview of Cochrane systematic reviews. Respir Med 2007;101(10):2037-43.

Ceyhan M, Yildirim I, Balmer P, et al. A prospective study of etiology of childhood acute bacterial meningitis, Turkey. Emerg Infect Dis 2008;14(7):1089-96.

Theodoridou MN, Vasilopoulou VA, Atsali EE, et al. Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period. BMC Infect Dis 2007;7:101.

Holmquist L, Russo CA, Elixhauser A. Meningitis-related hospitalizations in the United States, 2006: Statistical Brief #57. HCUP. (Accessed in May 2015, 5, at

Domingo P, Barquet N, Alvarez M, et al. Group B streptococcal meningitis in adults: report of twelve cases and review. Clin Infect Dis 1997;25(5): 1180-7.

Ghotaslou R, Farajnia S, Yeganeh F, et al. Detection of acute childhood meningitis by PCR, culture and agglutination test at Tabriz, Iran. Acta Med Iran 2012;50(3):192-6.

Sasan MS, Naderinasab M, Kafi M, et al. The Role of HEMOPHILUS INFLUENZA TYPE B in Pediatric meningitis. Med J Mashhad Univ Med Sci 2009;52(3):141-6.

Alborzi AV, Vahedi F, Karimi A. Bacterial etiology of acute childhood meningitis in Shiraz, Iran: Incidence, clinical pictures, complications and antibiotic sensitivity pattern. Iran J Infect Dis Trop Med 2002;7(18):26-31.

Yousefi Mashouf R, Hashemi SH, Shams S. Study of bacterial agents of meningitis in children and detection of antibiogram patterns in Hamadan. YJMS 2004;5(17):31-7.

Bahador M, Amini M, Bahador M. Common cause and cerebrospinal fluid changes of acute bacterial meningitis. Iranian J Pathol 2009;4(2):75-9.

Modares S, Rahbari AA. Study of Bacterial and viral meningitis with CRPIN cerebrospinal fluid of children in Tehran. Journal of Medical Council of I.R.I 2002;20(1):17-20.

Haghiashteiani MT, Mohammadi-Yeganeh S, Soroush S, et al. Frequency and antimicrobial susceptibility of Haemophilus influenzae Type b isolated from children suspected to meningitis. Iranian J Publ Health 2008;37(4):52-8.

Hojjati Bonab Z, Farajnia S, Ghotaslou R, et al. Evaluation of nested PCR method for diagnosis of meningitis due to Neisseria meningitidis and Haemophilus influenzae. Turk J Biol 2012;36(6):727-31.

Sarookhani MR, Ayazi P, Alizadeh S, et al. Comparison of 16S rDNA-PCR amplification and culture of cerebrospinal fluid for diagnosis of bacterial meningitis of bacterial meningitis. Journal of Mazandaran University of Medical Sciences 2009; 18 (69):14-21.

Taheri KM, Akbari NF, Kazemi B, et al. Survey rate isolation of Haemophilus influenzae type b in CSF of pediatrics suspected meningitis by culture and PCR Tehran Center of Medical Children. TUMJ 2006;63(12):1006-14.

Rezaeizadeh G, Pourakbari B, Ashtiani MH, et al. Antimicrobial susceptibility of bacteria isolated from cerebrospinal fluids in an Iranian referral pediatric center, 1998-2008. Maedica (Buchar) 2012;7(2):131-7.

Alavi SM, Moshiri N, Shokri S. Evaluation of epidemiological, clinical and laboratory findings of admitted patients with meningitis in Infectious Diseases Ward of Razi Hospital, Ahvaz. Jundishapur Scientific Medical Journal 2010;6(3):222-31.

Tabatabaei P, Siadati A, Mamishi S, et al. A 10- year survey of bacterial meningitis in pediatric patients admitted to children medical center. JSMJ 2007;6(3): 324-9.

Zamani A, Zamani F. Cerebrospinal fluid findings in neonatal bacterial meningitis. MJIRI 2005;19(3):241-5.

Borjian S. The common agents of bacterial Meningitis in children in Borujen. SHUMJ 1999;1(2):52-8.

Ataei RA, Mehrabi TA, Ghorbani GHH, et al. Determination of bacterial etiology of 100 CSF samples of patients with Meningitis at four military hospitals in Tehran between 2003 and 2005. Mil Med 2005;7(1):49-56.

Noorbakhsh S, Siadati SA, Rimaz SH, et al. Determination of appropriate antibiotic in bacterial meningitis children based on MIC. Tehran Univ Med J 2005;63(1):68-76.

Ghaemi E, Mohammadian S, Abdollahmohammadi L, Mansourian Azad R, Behnampour N, tondkar R. Paraclinical and clinical findings in 100 patients with suspected meningitis. J Gorgan Uni Med Sci 2001;3(7):17-23.

Schuchat A, Robinson K, Wenger JD, et al. Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med 1997;337(14):970-6.

Owusu M, Nguah SB, Boaitey YA, et al. Aetiological agents of cerebrospinal meningitis: a retrospective study from a teaching hospital in Ghana. Ann Clin Microbiol Antimicrob 2012;11(1):1-8.

Kim KS. Acute bacterial meningitis in infants and children. Lancet Infect Dis 2010;10(1):32-42.

Chen Y, Deng W, Wang SM, et al. Burden of pneumoniae and meningitis caused by Streptococcus pneumoniae in China among children under 5 years of age: a systematic literature review. PLoS One 2011;6(11):1-9.

Furyk JS, Swann O, Molyneux E. Systematic review: neonatal meningitis in the developing world. Trop Med Int Health 2011;16(6):672-9.

Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med 2011;364(21):2016-25.

Grandgirard D, Gäumann R, Coulibaly B, et al. The causative pathogen determines the inflammatory profile in cerebrospinal fluid and outcome in patients with bacterial meningitis. Mediators Inflamm 2013;2013:312476.

Arda B, Sipahi OR, Atalay S, et al. Pooled analysis of 2,408 cases of acute adult purulent meningitis from Turkey. Med Princ Pract 2008;17(1):76-9.

Bhimraj A. Acute community-acquired bacterial meningitis in adults: an evidence-based review. Cleve Clin J Med 2012;79(6):393-400.

Milledge J, Calis JC, Graham SM, et al. Aetiology of neonatal sepsis in Blantyre, Malawi: 1996-2001. Ann Trop Paediatr 2005;25(2):101-10.

Gebremariam A. Neonatal meningitis in Addis Ababa: a 10-year review. Ann Trop Paediatr 1998;18(4):279-83.

Longe AC, Omene JA, Okolo AA. Neonatal meningitis in Nigerian infants. Acta Paediatr Scand 1984;73(4):477-81.

Berardi A, Lugli L, Rossi C, et al. Infezioni da Streptococco B Della Regione Emilia Romagna. Neonatal bacterial meningitis. Minerva Pediatr 2010;62(3):51-4.

Centers for Disease Control and Prevention (2006) Vaccine preventable deaths and the Global Immunization Vision and Strategy, 2006–2015. MMWR Morb Mortal Wkly Rep 2006;55(18):511-5.

How to Cite
Ghotaslou R, Yeganeh-Sefidan F, Salahi-Eshlaqi B, Ebrahimzadeh-Leylabadlo H. Etiology of Acute Bacterial Meningitis in Iran: a Systematic Review. Acta Med Iran. 53(8):454-461.
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