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The aetiology of purulent meningitis in highland children: a bacteriological study
Abstract:
Of 155 highlands children with purulent culture-positive meningitis studied from March 1980 to September 1984, 84% were aged twelve months or less and 92% were infected with either Haemophilus influenzae, Streptococcus pneumoniae or both organisms. Other pathogens were Neisseria meningitidis (8 isolations), Streptococcus pyogenes (2 isolations) and Streptococcus agalactiae and Klebsiella species (1 of each). Among H. influenzae isolates, serotype b strains predominated (83%) and most (96%) belonged to biotype I or II. Infections due to non-b haemophili included serotype a (9 strains), serotype f (1 strain) and non-serotypable variants (3 strains). Of 67 S. pneumoniae strains 22% were resistant to benzylpenicillin, with minimal inhibitory concentrations of 0.1-1.0 micrograms/ml. The commonest serotypes were types 5 (11 isolates), type 7 (9 isolates) and types 2, 6 and 46 (6 of each). No resistance to chloramphenicol was detected in either H. influenzae or S. pneumoniae and only one of 56 strains of H. influenzae was insensitive to betalactam antibiotics. The known case fatality rate in this study was 37%. More children with pneumococcal infection died (46%) than those with haemophilus infection (30%), though the difference was not statistically significant; 79% of all deaths occurred in children aged less than twelve months. There is an urgent need for H. influenzae and S. pneumoniae vaccines that are effective in young children.
Insights
Purulent meningitis in children is primarily caused by Haemophilus influenzae and Streptococcus pneumoniae, especially in infants. Vaccines targeting these bacteria are urgently needed for young children to reduce mortality.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Meningitis is a serious infection affecting children, particularly infants.
- Identifying causative pathogens is crucial for effective treatment and prevention.
Purpose of the Study:
- To analyze the etiological agents of purulent meningitis in highlands children.
- To determine the antimicrobial susceptibility patterns of common bacterial isolates.
- To assess the mortality rates associated with different pathogens and age groups.
Main Methods:
- Retrospective analysis of culture-positive meningitis cases from March 1980 to September 1984.
- Identification of bacterial pathogens and serotyping of isolates.
- Antimicrobial susceptibility testing for key antibiotics.
Main Results:
- Haemophilus influenzae (predominantly serotype b) and Streptococcus pneumoniae were the most common pathogens (92%).
- 22% of S. pneumoniae isolates showed benzylpenicillin resistance.
- The overall case fatality rate was 37%, with higher mortality in infants and pneumococcal meningitis cases.
Conclusions:
- Haemophilus influenzae and Streptococcus pneumoniae are the leading causes of bacterial meningitis in this pediatric population.
- The prevalence of antibiotic resistance and high mortality underscore the need for effective vaccines.
- Vaccination strategies should prioritize young children to reduce the burden of meningitis.
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