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Argirova PK, Kalchev YI, Boev IP, Vatev NT, Murdjeva MA, Vartigova MS. A comparative study between children and adults with bacterial neuroinfections. Folia Med (Plovdiv) 2022; 64:408-414. [PMID: 35856101 DOI: 10.3897/folmed.64.e65456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/18/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract.
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Affiliation(s)
| | | | - Ivan P Boev
- Medical University of Plovdiv, Plovdiv, Bulgaria
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Rahimi BA, Ishaq N, Mudaser GM, Taylor WR. Outcome of acute bacterial meningitis among children in Kandahar, Afghanistan: A prospective observational cohort study. PLoS One 2022; 17:e0265487. [PMID: 35404980 PMCID: PMC9000062 DOI: 10.1371/journal.pone.0265487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 03/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Acute bacterial meningitis (ABM) is an important cause of morbidity and mortality in children but there are no published data on the treatment outcomes of ABM in Afghanistan. METHODS We conducted a prospective observational cohort study over one year, February 2020 to January 2021 in a tertiary care hospital in Kandahar, Afghanistan. AMB was diagnosed clinically and on lumbar puncture findings. Binary logistic regression assessed factors for death. RESULTS A total of 393 ABM children of mean age 4.8 years were recruited. Most were males [231 (58.8%)], living in rural areas [267 (67.9%)] and in households of >10 inhabitants [294 (74.8%)]. Only 96 (24.4%) had received against both Haemophilus influenzae type b (Hib) or pneumococcal (PCV) vaccines. Children were treated with combination of ceftriaxone and ampicillin and 169/321 (52.6%) received dexamethasone. Of the 321 children with a known outcome, 69 (21.5%) died. Death was significantly associated with: not receiving dexamethasone [adjusted odds ratio (AOR) 4.9 (95% CI 2.6-9.5, p <0.001)], coma on admission [AOR 4.6 (I 2.3-9.5, p <0.001)], no PCV [AOR 2.8 (1.2-6.6, p = 0.019)] or Hib vaccine [AOR 2.8 (1.2-6.6, p = 0.019)], and being male [AOR 2.7 (1.4-5.5, p = 0.005). CONCLUSIONS ABM causes significant morbidity and mortality in Afghan children that may be improved by greater use of PCV and Hib vaccines. Adjunct dexamethasone should be evaluated formally in our setting.
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Affiliation(s)
- Bilal Ahmad Rahimi
- Department of Pediatrics, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
- Research Unit of Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | - Niamatullah Ishaq
- Department of Radiology, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | | | - Walter R. Taylor
- Mahidol Oxford Tropical Medicine Clinical Research unit (MORU), Mahidol University, Bangkok, Thailand
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Congdon M, Hong H, Young RR, Cunningham CK, Enane LA, Arscott-Mills T, Banda FM, Chise M, Motlhatlhedi K, Feemster K, Patel SM, Boiditswe S, Leburu T, Shah SS, Steenhoff AP, Kelly MS. Effect of Haemophilus influenzae Type b and 13-Valent Pneumococcal Conjugate Vaccines on Childhood Pneumonia Hospitalizations and Deaths in Botswana. Clin Infect Dis 2021; 73:e410-e416. [PMID: 32634831 PMCID: PMC8282259 DOI: 10.1093/cid/ciaa919] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 06/29/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Globally, pneumonia is the leading cause of death among children. Few data exist regarding the effect of Haemophilus influenzae type b (Hib) vaccine and 13-valent pneumococcal conjugate vaccine (PCV-13) on the burden of childhood pneumonia in African settings. METHODS We collected data on children aged 1 to 59 months at 3 hospitals in Botswana. Hib vaccine and PCV-13 were introduced in Botswana in November 2010 and July 2012, respectively. We compared pneumonia hospitalizations and deaths prevaccine (January 2009 to October 2010) with postvaccine (January 2013 to December 2017) using seasonally adjusted, interrupted time-series analyses. RESULTS We identified 6943 pneumonia hospitalizations and 201 pneumonia deaths. In the prevaccine period, pneumonia hospitalizations and deaths increased by 24% (rate, 1.24; 95% CI, .94-1.64) and 59% (rate, 1.59; 95% CI, .87-2.90) per year, respectively. Vaccine introduction was associated with a 48% (95% CI, 29-62%) decrease in the number of pneumonia hospitalizations and a 50% (95% CI, 1-75%) decrease in the number of pneumonia deaths between the end of the prevaccine period (October 2010) and the beginning of the postvaccine period (January 2013). During the postvaccine period, pneumonia hospitalizations and deaths declined by 6% (rate, .94; 95% CI, .89-.99) and 22% (rate, .78; 95% CI, .67-.92) per year, respectively. CONCLUSIONS Pneumonia hospitalizations and deaths among children declined sharply following introduction of Hib vaccine and PCV-13 in Botswana. This effect was sustained for more than 5 years after vaccine introduction, supporting the long-term effectiveness of these vaccines in preventing childhood pneumonia in Botswana.
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Affiliation(s)
- Morgan Congdon
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hwanhee Hong
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca R Young
- Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Coleen K Cunningham
- Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Leslie A Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tonya Arscott-Mills
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Botswana–UPenn Partnership, Gaborone, Botswana
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Francis M Banda
- Botswana–UPenn Partnership, Gaborone, Botswana
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | | | - Keneilwe Motlhatlhedi
- Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
| | - Kristen Feemster
- Division of Pediatric Infectious Diseases and Global Health Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Sweta M Patel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University, Durham, North Carolina, USA
| | | | | | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children’s Medical Center, Cincinnati, Ohio, USA
| | - Andrew P Steenhoff
- Department of Pediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
- Division of Pediatric Infectious Diseases and Global Health Center, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matthew S Kelly
- Division of Pediatric Infectious Diseases, Duke University, Durham, North Carolina, USA
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Obiero CW, Mturi N, Mwarumba S, Ngari M, Newton C, Boele van Hensbroek M, Berkley JA. Clinical features to distinguish meningitis among young infants at a rural Kenyan hospital. Arch Dis Child 2021; 106:130-136. [PMID: 32819909 PMCID: PMC7841476 DOI: 10.1136/archdischild-2020-318913] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Detection of meningitis is essential to optimise the duration and choice of antimicrobial agents to limit mortality and sequelae. In low and middle-income countries most health facilities lack laboratory capacity and rely on clinical features to empirically treat meningitis. OBJECTIVE We conducted a diagnostic validation study to investigate the performance of clinical features (fever, convulsions, irritability, bulging fontanel and temperature ≥39°C) and WHO-recommended signs (drowsiness, lethargy, unconsciousness, convulsions, bulging fontanel, irritability or a high-pitched cry) in discriminating meningitis in young infants. DESIGN Retrospective cohort study. SETTING Kilifi County Hospital. PATIENTS Infants aged <60 days hospitalised between 2012 and 2016. MAIN OUTCOME MEASURE Definite meningitis defined as positive cerebrospinal fluid (CSF) culture, microscopy or antigen test, or leucocytes ≥0.05 x 10∧9/L. RESULTS Of 4809 infants aged <60 days included, 81 (1.7%) had definite meningitis. WHO-recommended signs had sensitivity of 58% (95% CI 47% to 69%) and specificity of 57% (95% CI 56% to 59%) for definite meningitis. Addition of history of fever improved sensitivity to 89% (95% CI 80% to 95%) but reduced specificity to 26% (95% CI 25% to 27%). Presence of ≥1 of 5 previously identified signs had sensitivity of 79% (95% CI 69% to 87%) and specificity of 51% (95% CI 50% to 53%). CONCLUSIONS Despite a lower prevalence of definite meningitis, the performance of previously identified signs at admission in predicting meningitis was unchanged. Presence of history of fever improves the sensitivity of WHO-recommended signs but loses specificity. Careful evaluation, repeated assessment and capacity for lumbar puncture and CSF microscopy to exclude meningitis in most young infants with potential signs are essential to management in this age group.
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Affiliation(s)
- Christina W Obiero
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Global Health, University of Amsterdam Faculty of Medicine, Amsterdam, Noord-Holland, The Netherlands
| | - Neema Mturi
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salim Mwarumba
- Department of Microbiology, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Moses Ngari
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Charles Newton
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford Centre for Tropical Medicine and Global Health, Oxford, Oxfordshire, UK
| | - Michael Boele van Hensbroek
- Department of Global Health, University of Amsterdam Faculty of Medicine, Amsterdam, Noord-Holland, The Netherlands
| | - James Alexander Berkley
- Clinical Research Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition (CHAIN) Network, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford Centre for Tropical Medicine and Global Health, Oxford, Oxfordshire, UK
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Ali M, Chang BA, Johnson KW, Morris SK. Incidence and aetiology of bacterial meningitis among children aged 1-59 months in South Asia: systematic review and meta-analysis. Vaccine 2018; 36:5846-5857. [PMID: 30145101 DOI: 10.1016/j.vaccine.2018.07.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/22/2018] [Accepted: 07/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Bacterial meningitis is a significant cause of morbidity and mortality worldwide among children aged 1-59 months. We aimed to describe its burden in South Asia, focusing on vaccine-preventable aetiologies. METHODS We searched five databases for studies published from January 1, 1990, to April 25, 2017. We estimated incidence and aetiology-specific proportions using random-effects meta-analysis. In secondary analyses, we described vaccine impact and pneumococcal meningitis serotypes. RESULTS We included 48 articles cumulatively reporting 20,707 cases from 1987 to 2013. Mean annual incidence was 105 (95% confidence interval [CI], 53-173) cases per 100,000 children. On average, Haemophilus influenzae type b (Hib) accounted for 13% (95% CI, 8-19%) of cases, pneumococcus for 10% (95% CI, 6-15%), and meningococcus for 1% (95% CI, 0-2%). These meta-analyses had substantial between-study heterogeneity (I2 > 78%, P < 0.0001). Among studies reporting only confirmed cases, these three bacteria caused a median of 78% cases (IQR, 50-87%). Hib meningitis incidence declined by 72-83% at sentinel hospitals in Pakistan and Bangladesh, respectively, within two years of implementing nationwide vaccination. On average, PCV10 covered 49% (95% CI, 39-58%), PCV13 covered 51% (95% CI, 40-61%), and PPSV23 covered 74% (95% CI, 67-80%) of pneumococcal meningitis serotypes. Lower PCV10 and PCV13 serotype coverage in Bangladesh was associated with higher prevalence of serotype 2, compared to India and Pakistan. CONCLUSIONS South Asia has relatively high incidence of bacterial meningitis among children aged 1-59 months, with vaccine-preventable bacteria causing a substantial proportion. These estimates are likely underestimates due to multiple epidemiological and microbiological factors. Further research on vaccine impact and distribution of pneumococcal serotypes will inform vaccine policymaking and implementation.
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Affiliation(s)
- Mohsin Ali
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Brian A Chang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kipp W Johnson
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, USA; Institute for Next Generation Healthcare, Icahn Institute for Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Shaun K Morris
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Canada; Centre for Global Child Health, Hospital for Sick Children Research Institute, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada.
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Zeeshan F, Bari A, Dugal MN, Saeed F. Hearing impairment after acute bacterial meningitis in children. Pak J Med Sci 2018; 34:655-659. [PMID: 30034433 PMCID: PMC6041555 DOI: 10.12669/pjms.343.14373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 04/25/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the incidence of hearing loss after acute episode of meningitis in children. METHODS A descriptive study carried out in the Department of Pediatric Medicine of The Children's Hospital Lahore, Pakistan from January 2014 to July 2016. A total of 175 children one month to 13 years of age admitted with diagnosis of meningitis were included. Complete blood count, CSF cytology, biochemistry and culture sensitivity were sent. CT scan brain was done if required. Hearing assessment was done two weeks after admission using otoacoustic emissions in the patients having normal tympanogram. Hearing impairment was classified as sensorineural if otoacoustic emissions were absent while tympanometry was normal. RESULTS Of 175 children, 58% were males and 42% were females. Mean age was 2.1 years. Orientation as assessed by Glasgow comma scale (GCS) was normal in 63% while 5% had GCS<8 and 32% had GCS between 8 and 15. Signs of meningeal irritation were seen in 58% while focal signs only in 4%. In 15 % cases CT scan was done, out of which 73% showed abnormal findings. Otoacoustic emissions were absent in 22% of cases. Risk factors of hearing deficit were stay duration of more than 10 days (p=0.04), low GCS at presentation (p=0.009) and meningitis with complications (p=0.008). CONCLUSION The frequency of hearing loss is 22% following acute episode of meningitis which necessitates the need for implementation of screening assessment after meningitis in Pakistan. Prolonged stay, low GCS and complicated meningitis are risk factors for hearing impairment.
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Affiliation(s)
- Fatima Zeeshan
- Dr. Fatima Zeeshan, MRCPCH (UK), FCPS. Department of Paediatric Medicine, The Children’s Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Attia Bari
- Dr. Attia Bari, DCH, MCPS, FCPS, MHPE. Department of Paediatric Medicine, The Children’s Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Mubeen Nazar Dugal
- Dr. Mubeen Nazar Dugal, FCPS Department of Paediatric Medicine,. The Children’s Hospital and The Institute of Child Health, Lahore, Pakistan
| | - Fauzia Saeed
- Dr. Fauzia Saeed, MSC Audiology, Department of Audiology, The Children’s Hospital and The Institute of Child Health, Lahore, Pakistan
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Nour M, Alaidarous A. Clinical usefulness and accuracy of polymerase chain reaction in the detection of bacterial meningitis agents in pediatric cerebrospinal fluid. Curr Res Transl Med 2018; 66:15-18. [PMID: 29456197 DOI: 10.1016/j.retram.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/11/2017] [Accepted: 01/05/2018] [Indexed: 11/25/2022]
Abstract
Bacterial meningitis poses enormous healthcare challenges due to a high mortality, morbidity and sequelae. Neisseria (N.) meningitidis, Haemophilus (H.) influenzae, Streptococcus (S.) pneumoniae and S. agalactiae remain among the most prevalent infectious agents that cause bacterial meningitis in children. The objective of this study was the simultaneous detection of these pathogens in suspected cerebrospinal fluid (CSF) by using multiplex polymerase chain reaction (mPCR) and compare PCR results with standard diagnostics currently used in clinical practice. CSF specimens were obtained from 515 children (<5 years) clinically suspected of having acute bacterial meningitis. Based on bacterial culture, four isolates of salmonella sp and one Citrobacter freundii isolate were identified. The remaining 510 CSF specimens, having negative culture, were subjected to mPCR. Twenty-three (4.51%) CSF samples yielded a PCR positive signal. The pathogens identified were: S. pneumoniae (n=13), H. influenzae (n=7) and N. meningitidis (n=3). S. agalactiae was not detected. Using sequential multiplex PCR, serogrouping of S. pneumoniae revealed 3 different serotypes: serotype 19A (n=6), 19F (n=4) and serotype 23F (n=3). Only the serotype A was identified for the 3N. meningitidis isolates. Despite vaccination, S. pneumoniae remains a leading cause of pediatric invasive disease. Detecting causative organism remains the most critical aspect for management of children with suspected meningitis. PCR method is more sensitive and rapid than culture for detecting the infectious agents. Institution of PCR diagnostics is recommended for early and appropriate therapy.
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Affiliation(s)
- M Nour
- Department of biology, faculty of science, Taif university, KSA, 21974 Taif-Al-Haweiah, Saudi Arabia; Department of biology, high institute of biotechnology, Monastir university, Tahar-Haddad Street, 5000 Monastir, Tunisia.
| | - A Alaidarous
- Department of biology, faculty of science, Taif university, KSA, 21974 Taif-Al-Haweiah, Saudi Arabia
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Kaspar A, Kei J, Driscoll C, Swanepoel DW, Goulios H. Overview of a public health approach to pediatric hearing impairment in the Pacific Islands. Int J Pediatr Otorhinolaryngol 2016; 86:43-52. [PMID: 27260578 DOI: 10.1016/j.ijporl.2016.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Childhood hearing impairment is a significant cause of disability in developing countries. Otitis media and meningitis are leading infectious causes of preventable hearing loss in children. It is estimated that the Pacific Islands have among the greatest global burden of childhood hearing impairment due to infectious causes, and yet there is currently very little in the research literature on pediatric hearing disorders in this region. OBJECTIVES (1) To review existing research literature on pediatric hearing impairment in the Pacific Islands, and (2) to present a public health approach to the development and improvement of childhood hearing services in the Pacific Islands. DATA The primary tool was a comprehensive literature review. MEDLINE and ScienceDirect databases were searched for relevant journal articles. There was no limit on the date of publication. Any article reporting on hearing impairment in the Pacific Region was included. RESULTS A total of 23 journal articles were found that satisfied the above inclusion criteria. The limited information available in the literature suggests that otitis media and vaccine-preventable infections are a significant cause of avoidable childhood hearing impairment in the Pacific Islands. Pediatric audiology services are limited in this region. Further research is required to develop effective public health programs that should reduce the burden of preventable childhood hearing loss in the Pacific Islands. CONCLUSIONS There is limited information in the research literature on pediatric hearing impairment and audiology services in the Pacific Islands. Epidemiological data based on the WHO Ear and Hearing Disorders Survey Protocol are urgently needed, and the development of audiology services within the existing public and primary health care framework should reduce the burden of preventable hearing loss in the Pacific Islands.
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Affiliation(s)
- Annette Kaspar
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Australia; ENT Clinic, National Referral Hospital, Honiara, Solomon Islands.
| | - Joseph Kei
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Carlie Driscoll
- Hearing Research Unit for Children, School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - De Wet Swanepoel
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Helen Goulios
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Australia
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Shakoor S, Malik FR, Khan E. Bacterial aetiology of otitis media in children in Pakistan aged 0-59 months; laboratory surveillance data from 2004 to 2013: comparison between before and after the introduction of Hib vaccination. Paediatr Int Child Health 2016; 36:34-8. [PMID: 25631889 DOI: 10.1179/2046905514y.0000000170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Otitis media (OM) is a leading cause of childhood illness. In Pakistan, the estimated incidence of OM-associated hearing impairment is >40/10,000 population and OM-associated mortality is 50-79·9/10×10(6) population. No OM microbiology data are available from Pakistan since 2004. OBJECTIVES To describe the microbiology of OM in children aged 0-59 months in Pakistan. METHODS Laboratory data on ear pus specimens taken from children seen between 2004 and 2013 were retrieved from the Laboratory Information Systems of the Aga Khan University and entered into Microsoft Excel and SPSS version 16.0. RESULTS Bacterial culture results from 277 specimens were analysed. Staphylococcus aureus and Pseudomonas aeruginosa were the organisms most commonly isolated, followed by Streptococcus pneumoniae and Haemophilus influenzae. Polymicrobial cultures significantly increased in the post-Hib vaccination period from 19·5% to 32·7% (P = 0·038). H. influenzae also increased significantly from 16·8% to 24·5% (P = 0·038). CONCLUSIONS An increase in H. influenzae may reflect non-b capsular types (not determined in the study), or even capsular types from areas with low vaccine coverage. Increases in polymicrobial cultures and H. influenzae warrant further study.
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Affiliation(s)
- Sadia Shakoor
- Departments of Pathology & Microbiology, Aga Khan University , Karachi, Pakistan
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Moayedi AR, Nejatizadeh A, Mohammadian M, Rahmati MB, Namardizadeh V. Accuracy of universal polymerase chain reaction (PCR) for detection of bacterial meningitis among suspected patients. Electron Physician 2015; 7:1609-12. [PMID: 26816587 PMCID: PMC4725414 DOI: 10.19082/1609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Accepted: 08/23/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Central nervous system (CNS) infections are life-threatening diseases caused by viral, bacterial, parasitic and fungal microorganisms. The aim of this study was to determine the accuracy of universal polymerase chain reaction (PCR) for the detection of bacterial meningitis among patients who were referred to Koodakan Hospital in Bandar Abbas because they were suspected of having the disease. Methods This study was conducted in 2013 on the patients who were admitted to Bandar Abbas’ Koodakan Hospital because they were suspected of having meningitis. A questionnaire, including demographic data, was completed for each patient. Universal PCR, Cerebrospinal fluid (CSF) analysis, and gram staining and cultures were done for all the patients. The data were analyzed using SPSS software. Results Among the 100 patients studied 59 (59%) were male and 41 (41%) were female. No patient in our study had a positive smear and culture for meningitis. Among the patients with negative smears and cultures six (6%) had positive universal PCR, and 94 (94%) had negative universal PCR. Based on these results, PCR had 95% specificity and 100% negative predictive value for the prediction of meningitis. In 30 patients (30%), the biochemical analysis of CSF were in favor of meningitis. Among the 30 patients, six patients (20%) had positive universal PCR and 24 patients (80%) had negative universal PCR. Conclusion Based on our results, the universal PCR test is useful in the diagnosis of bacterial meningitis in children. We recommend using it in combination with other tests, such as CSF analysis, for diagnosis of bacterial meningitis.
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Affiliation(s)
- Ali Reza Moayedi
- M.D., Assistant Professor, Department of Pediatric Neurology, Faculty of Medicine, Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Abdolazim Nejatizadeh
- Ph.D. of Genetics, Associate Professor, Department of Genetics, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Maryam Mohammadian
- M.D., Pediatric Resident, Department of Pediatrics, Faculty of Medicine, Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammad Bagher Rahmati
- M.D., Assistant Professor, Department of Pediatric Infectious Diseases, Faculty of Medicine, Infectious and tropical diseases research center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Vahideh Namardizadeh
- B.Sc., Department of Genetics, Faculty of Medicine, Khalije-Fars Molecular Medicine Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Ceyhan M, Gürler N, Ozsurekci Y, Keser M, Aycan AE, Gurbuz V, Salman N, Camcioglu Y, Dinleyici EC, Ozkan S, Sensoy G, Belet N, Alhan E, Hacimustafaoglu M, Celebi S, Uzun H, Faik Oner A, Kurugol Z, Ali Tas M, Aygun D, Karadag Oncel E, Celik M, Yasa O, Akin F, Coşkun Y. Meningitis caused by Neisseria Meningitidis, Hemophilus Influenzae Type B and Streptococcus Pneumoniae during 2005-2012 in Turkey. A multicenter prospective surveillance study. Hum Vaccin Immunother 2014; 10:2706-12. [PMID: 25483487 DOI: 10.4161/hv.29678] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Successful vaccination policies for protection from bacterial meningitis are dependent on determination of the etiology of bacterial meningitis. Cerebrospinal fluid (CSF) samples were obtained prospectively from children from 1 month to ≤18 years of age hospitalized with suspected meningitis, in order to determine the etiology of meningitis in Turkey. DNA evidence of Neisseria meningitidis (N. meningitidis), Streptococcus pneumoniae (S. pneumoniae), and Hemophilus influenzae type b (Hib) was detected using multiplex polymerase chain reaction (PCR). In total, 1452 CSF samples were evaluated and bacterial etiology was determined in 645 (44.4%) cases between 2005 and 2012; N. meningitidis was detected in 333 (51.6%), S. pneumoniae in 195 (30.2%), and Hib in 117 (18.1%) of the PCR positive samples. Of the 333 N. meningitidis positive samples 127 (38.1%) were identified as serogroup W-135, 87 (26.1%) serogroup B, 28 (8.4%) serogroup A and 3 (0.9%) serogroup Y; 88 (26.4%) were non-groupable. As vaccines against the most frequent bacterial isolates in this study are available and licensed, these results highlight the need for broad based protection against meningococcal disease in Turkey.
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Affiliation(s)
- Mehmet Ceyhan
- a Department of Pediatric Infectious Diseases ; Hacettepe University Faculty of Medicine ; Ankara , Turkey
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Shakoor S, Kabir F, Khowaja AR, Qureshi SM, Jehan F, Qamar F, Whitney CG, Zaidi AKM. Pneumococcal serotypes and serogroups causing invasive disease in Pakistan, 2005-2013. PLoS One 2014; 9:e98796. [PMID: 24892937 PMCID: PMC4043782 DOI: 10.1371/journal.pone.0098796] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/06/2014] [Indexed: 11/19/2022] Open
Abstract
While pneumococcal conjugate vaccines have been implemented in most countries worldwide, use in Asia has lagged in part because of a lack of data on the amount of disease that is vaccine preventable in the region. We describe pneumococcal serotypes elicited from 111 episodes of invasive pneumococcal disease (IPD) from 2005 to 2013 among children and adults in Pakistan. Seventy-three percent (n = 81) of 111 IPD episodes were cases of meningitis (n = 76 in children 0–15 years and n = 5 among adults). Serotypes were determined by target amplification of DNA extracted from pneumococcal isolates (n = 52) or CSF specimens (n = 59). Serogroup 18 was the most common serogroup causing meningitis in children <5 years, accounting for 21% of cases (n = 13). The 10-valent pneumococcal conjugate vaccine (PCV 10) or PCV10- related serotypes were found in 61% (n = 47) of childhood (age 0–15 years) meningitis episodes. PCV-13 increased this coverage to 63% (one additional serotype 19A; n = 48). Our data indicate that use of PCVs would prevent a large proportion of serious pneumococcal disease.
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Affiliation(s)
- Sadia Shakoor
- Department of Pediatrics and Child Health, the Aga Khan University Hospital, Karachi, Pakistan
- Department of Pathology and Microbiology, the Aga Khan University Hospital, Karachi, Pakistan
| | - Furqan Kabir
- Department of Pediatrics and Child Health, the Aga Khan University Hospital, Karachi, Pakistan
| | - Asif R. Khowaja
- Department of Pediatrics and Child Health, the Aga Khan University Hospital, Karachi, Pakistan
| | - Shahida M. Qureshi
- Department of Pediatrics and Child Health, the Aga Khan University Hospital, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, the Aga Khan University Hospital, Karachi, Pakistan
| | - Farah Qamar
- Department of Pediatrics and Child Health, the Aga Khan University Hospital, Karachi, Pakistan
| | - Cynthia G. Whitney
- National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia, United States of America
| | - Anita K. M. Zaidi
- Department of Pediatrics and Child Health, the Aga Khan University Hospital, Karachi, Pakistan
- * E-mail:
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Hajjeh R, Mulholland K, Schuchat A, Santosham M. Progress towards demonstrating the impact of Haemophilus influenzae type b conjugate vaccines globally. J Pediatr 2013; 163:S1-3. [PMID: 23773587 PMCID: PMC5748936 DOI: 10.1016/j.jpeds.2013.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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