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Are Pathogenic Leptospira a Possible Cause of Aseptic Meningitis in Suspected Children in Sudan?
Nada Abdelghani Abdelrahim1, Imad Mohammed Fadl-Elmula2, Rudy A Hartskeerl3
1Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, Nile University, Khartoum, Sudan.
Introduction:
Clinical presentations of leptospirosis are diverse, with meningitis easily confused with other microbial causes. We aimed to investigate the involvement of pathogenic leptospira in the cerebrospinal fluid (CSF) of meningitis-suspected children in Sudan.
Methods:
A total of 153 CSF specimens were collected over 5 months from patients attending a reference pediatric hospital in Omdurman, Sudan. All patients had provisionally been diagnosed with meningitis on admission. Demographic, clinical, and conventional laboratory findings were obtained. DNA was extracted using a QIAamp mini kit, and the secY gene investigated using real-time PCR.
Results:
Nine of 153 (6%) CSF specimens were positive for pathogenic leptospiral DNA. All these patients were male (seven infants and two toddlers aged ˂4 years). Typical conventional laboratory findings for aseptic meningitis (ie, CSF turbidity/pleocytosis, normal or reduced CSF glucose, normal or elevated proteins) were seen in five (56%). All patients presented with fever and seizures, 56% vomiting and stiff neck, and 29% bulging fontanel. Most (67%) patients presented in summer (March to May). Polymicrobial infections were identified in three patients (33%).
Conclusion:
We conclude that pathogenic leptospira are probably a common cause of meningitis in children in Sudan; therefore, we recommend including leptospirosis in the differential diagnosis of CNS infections and other undifferentiated febrile illnesses in this country.
Insights
Pathogenic leptospira DNA was detected in 6% of cerebrospinal fluid samples from children with suspected meningitis in Sudan. This suggests leptospirosis is a common cause of pediatric meningitis, requiring its inclusion in differential diagnoses.
Area of Science:
- Infectious Diseases
- Pediatrics
- Microbiology
Background:
- Leptospirosis presents diversely, often mimicking other microbial meningitis.
- Accurate diagnosis is crucial, especially in pediatric cases with overlapping symptoms.
Purpose of the Study:
- To investigate the prevalence of pathogenic *Leptospira* in cerebrospinal fluid (CSF) of children with suspected meningitis in Sudan.
- To determine the role of *Leptospira* in pediatric meningitis in the region.
Main Methods:
- CSF samples from 153 meningitis-suspected children in Sudan were analyzed.
- DNA extraction followed by real-time PCR targeting the *secY* gene was performed.
Main Results:
- Pathogenic *Leptospira* DNA was identified in 9 out of 153 (6%) CSF specimens.
- Affected children were predominantly male infants and toddlers, presenting with fever, seizures, and meningitis-like symptoms.
- Conventional meningitis findings were present in 56% of positive cases, with polymicrobial infections in 33%.
Conclusions:
- Pathogenic *Leptospira* are likely a significant cause of meningitis in Sudanese children.
- Leptospirosis should be considered in the differential diagnosis of central nervous system infections and febrile illnesses in Sudan.
