Traditional and molecular methods for diagnosing bacterial meningitis in Erbil city, Iraq
Keywords:Bacterial Meningitis, Blood Specimen, Cerebrospinal Fluid, Cultural characteristics, PCR
Bacterial meningitis is a leading cause of illness and death worldwide. It is crucial for clinical and public health care, as well as disease control, to identify the meningitis-causing agent promptly. Between June 2021-February 2022, a total of 100 cerebrospinal fluid (CSF) and blood samples were collected from suspected cases of meningitis admitted to Raparin Paediatric Teaching Hospital, Erbil city-Iraq. Cytochemical, cultural, and biochemical tests were conducted, and confirmed by molecular techniques. Bacterial culture findings were positive in 7% of CSF samples and just one positive among blood samples. The most common pathogens found by cultural characteristics and VITEK 2 Compact System were Staphylococcus sciuri in two cases 2%, Staphylococcus xylosus in one case 1%, Escherichia coli in two instances 2%, Enterococcus casseliflavus and Micrococcus luteus each in one case 1%. Staphylococcus sciuri, Staphylococcus xylosus, Enterococcus casseliflavus and Micrococcus luteus were first recorded as bacterial meningitis in Erbil/Iraq. All isolates were confirmed by PCR assay. All clinical isolates were screened for some antimicrobial sensitivity, meropenem and tobramycin have been shown to be totally resistant 100% to all isolated bacteria, furthermore, isolated E coli showed highly resistant 100 to cefotaxime, gentamycin, pencillin, ceftriaxone, rifampin, amoxicillin/clavulanic acid, ceftazidime, erythromycin, ampicillin, and clindamycin, while they were sensitive (100%) to amikacin and imipenem as well as all the gram positive bacteria were resistant 100% to optochin and sensitive (100%) to gentamycin, and trimethoprim. In bacterial meningitis patients, high C-reactive protein (CRP) >6 mg/dl, high CSF protein >50 mg/dl, low CSF glucose level <40 mg/dl and high leukocyte count >100 cells/mm3 were all substantially diagnostic.
Published Online First 20/07/2023
LaPenna PA, Roos KL. Bacterial infections of the central nervous system. Semin Neurol. 2019 Jun; 39(3): 334-342. Thieme Medical Publishers. https://doi.org/10.1055/s-0039-1693159
Oordt-Speets AM, Bolijn R, van Hoorn RC, Bhavsar A, Kyaw MH. Global etiology of bacterial meningitis: a systematic review and meta-analysis. PLoS One. 2018 Jun 11; 13(6): e0198772. https://doi.org/ 10.1371/journal.pone.0198772.
Jayaraman Y, Veeraraghavan B, Chethrapilly Purushothaman GK, Sukumar B, Kangusamy B, Nair Kapoor A, et al. Hospital Based Sentinel Surveillance of Bacterial Meningitis (HBSSBM) Network Team. Burden of bacterial meningitis in India: Preliminary data from a hospital based sentinel surveillance network. PLoS One. 2018 May 16; 13(5): e0197198. https://doi.org/ 10.1371/journal.pone.0197198.
Sameh MA, Hassan AS, Aya MA, Naglaa AK, Ahmed LS. Etiological and predictive factors of Acute Meningitis in Mansoura fever hospital, Egypt. Afr J Microbiol Res. 2021 Nov 4; 15(11): 554-62. https://doi.org/10.5897/AJMR2021.9576.
Abdelkader MM, Aboshanab KM, El-Ashry MA, Aboulwafa MM. Prevalence of MDR pathogens of bacterial meningitis in Egypt and new synergistic antibiotic combinations. PLoS One. 2017 Feb 16; 12(2): e0171349. https://doi.org/10.1371/journal.pone.0171349.
Alruqaie N, Falatah Y, Alzahrani F, Alharbi M. Case Report: Prolonged CSF PCR Positivity in a Neonate with GBS Meningitis. Front Pediatr. 2021 Nov 25; 9. https://doi.org/ 10.3389/fped.2021.752235.
Zeighami H, Roudashti S, Bahari S, Haghi F, Hesami N. Frequency of etiological agents of acute bacterial meningitis using culture and polymerase chain reaction assay. New Microbes and New Infect. 2021 Sep 1; 43:100930. https://doi.org/10.1016/j.nmni.2021.100930.
Leazer R, Erickson N, Paulson J, Zipkin R, Stemmle M, Schroeder AR, et al. Epidemiology of cerebrospinal fluid cultures and time to detection in term infants. Pediatrics. 2017 May 1; 139(5). https://doi.org/10.1542/peds.2016-3268.
İpek MŞ. Neonatal Bacterial Meningitis. Natl Med. 2019 Sep 10. IntechOpen. https://doi.org/10.5772/intechopen.87118.
Xu M, Hu L, Huang H, Wang L, Tan J, Zhang Y, et al. Etiology and clinical features of full-term neonatal bacterial meningitis: a multicenter retrospective cohort study. Front Pediatr. 2019 Feb 13; 7: 31. https://doi.org/10.3389/fped.2019.00031.
Huda ZA, Khalid AH, Kifah AA .Occurrence of Pneumococcal Meningitis in Iraq. Baghdad Sci J. 2012; 9(3): 466-471. https://doi.org/10.21123/bsj.2012.9.3.466-471.
Hrishi AP, Sethuraman M. Cerebrospinal fluid (CSF) analysis and interpretation in neurocritical care for acute neurological conditions. Indian J Crit Care Med: peer-reviewed. 2019 Jun; 23(Suppl 2): S115.
Hepnar D, Adam P, Žáková H, Krušina M, Kalvach P, Kasík J, et al. Recommendations for cerebrospinal fluid analysis. Folia microbiol. 2019 May; 64(3): 443-52. https://doi.org/10.1007/s12223-018-0663-7.
Ray P, Badarou-Acossi G, Viallon A, Boutoille D, Arthaud M, Trystram D, et al. Accuracy of the cerebrospinal fluid results to differentiate bacterial from non bacterial meningitis, in case of negative gram-stained smear. Am J Emerg Med. 2007 Feb 1; 25(2): 179-84. https://doi.org/ 10.1016/j.ajem.2006.07.012.
Dashti AS, Alizadeh S, Karimi A, Khalifeh M, Shoja SA. Diagnostic value of lactate, procalcitonin, ferritin, serum-C-reactive protein, and other biomarkers in bacterial and viral meningitis: a cross-sectional study. Medicine. 2017 Sep; 96(35): 1-7. http://dx.doi.org/10.1097/MD.0000000000007637.
Gerdes LU, Jørgenseny PE, Nexø E, Wang P. C-reactive protein and bacterial meningitis: a meta-analysis. Scand J Clin Lab Invest. 1998 Jan 1; 58(5): 383-94. https://doi.org/10.1080/00365519850186364.
Mahon CR, Lehman DC, Manuselis G. Textbook of diagnostic microbiology-e-book. 6th Ed. Elsevier Health Sciences; 2018 Jan 18.
Sharma N, Gautam H, Tyagi S, Raza S, Mohapatra S, Sood S, et al. Clinical use of multiplex-PCR for the diagnosis of acute bacterial meningitis. J Family Med Prim Care. 2022 Feb; 11(2): 593. https://doi.org/10.4103/jfmpc.jfmpc_1162_21.
Devi U, Bora R, Malik V, Deori R, Gogoi B, Das JK, et al. Bacterial aetiology of neonatal meningitis: A study from north-east India. Indian J Med Res. 2017 Jan; 145(1): 138. https://doi.org/10.4103/ijmr.IJMR_748_15.
Chen J, Griffiths MW. PCR differentiation of Escherichia coli from other Gram‐negative bacteria using primers derived from the nucleotide sequences flanking the gene encoding the universal stress protein. Lett Appl Microbiol. 1998 Dec; 27(6): 369-71. https://doi.org/10.1046/j.1472-765x.1998.00445.x.
Karmakar A, Dua P, Ghosh C. Biochemical and molecular analysis of Staphylococcus aureus clinical isolates from hospitalized patients. Can J Infect Dis Med Microbiol. 2016 Apr 24. https://doi.org/10.1155/2016/9041636.
Bousbia S, Papazian L, Auffray JP, Fenollar F, Martin C, Li W, et al. Tropheryma whipplei in patients with pneumonia. Emerg Infect Dis. 2010 Feb; 16(2): 258. https://doi.org/10.3201/eid1602.090610.
CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2020.
Delacroix R, Morel SN, Hervé L, Bordy T, Dinten JM, Drancourt M, et al. Cerebrospinal fluid lens-free microscopy: a new tool for the laboratory diagnosis of meningitis. Sci Rep. 2017 Jan 3; 7(1): 1-8. hptts://doi.org/10.1038/srep39893.
Ismail DK. Routine Use of 16S rRNA Gene Sequencing for Diagnosis of Culture-Negative Bacterial Infections in Body Fluids Other than Blood: Benefits in a Limited Resource Hospital. Egypt J Med Microbiol. 2022 Jan 1; 31(1): 15-21.
Chang JB, Wu H, Wang H, Ma BT, Wang RZ, Wei JJ. Prevalence and antibiotic resistance of bacteria isolated from the cerebrospinal fluid of neurosurgical patients at Peking Union Medical College Hospital. Antimicrob Resist Infect Control. 2018 Mar 20; 7(1): 1-6. https://doi.org/10.1186/s13756-018-0323-3.
Peros T, van Schuppen J, Bohte A, Hodiamont C, Aronica E, de Haan T. Neonatal bacterial meningitis versus ventriculitis: a cohort-based overview of clinical characteristics, microbiology and imaging. Eur J Pediatr. 2020 Dec; 179(12): 1969-77. https://doi.org/10.1007/s00431-020-03723-3.
Jeter K, Dang A, Ly A, Jayasekara D. Spontaneous Escherichia coli Meningitis and Brain Abscess in an Immunocompetent Adult. Cureus. 2022 Sep 3; 14(9): e28728. https://doi.org/10.7759/cureus.28728.
Gupta V, Chauhan A, Kumar RN, Dhyani A, Chakravarty S. Meningitis caused by Micrococcus luteus: case report and review of literature. IP Int J Med Microbiol Trop Dis. 2019; 5(1): 63-4. https://doi.org/10.18231/2581-4761.2019.0015.
Iaria C, Stassi G, Costa GB, Di Leo R, Toscano A, Cascio A. Enterococcal meningitis caused by Enterococcus casseliflavus. First case report. BMC Infect Dis. 2005 Dec; 5(1): 1-3. https://doi.org/10.1186/1471-2334-5-3.
Singh A, Jain R. Staphylococcus xylosus Meningitis Following Dog-bite. Indian pediatr. 2016 Oct 1; 53(10): 931.
Marsou R, Bes M, Boudouma M, Brun Y, Meugnier H, Freney J, et al. Distribution of Staphylococcus sciuri subspecies among human clinical specimens, and profile of antibiotic resistance. Res Microbiol. 1999 Oct 1; 150(8): 531-41. https://doi.org/10.1016/S0923-2508 (99)00104-7.
Bosshard PP, Abels S, Zbinden R, Bottger EC, Altwegg M. Ribosomal DNA sequencing for identification of aerobic gram-positive rods in the clinical laboratory (an 18-month evaluation). J clin Microbiol. 2003 Sep; 41(9): 4134-40. https://doi.org/10.1128/JCM.41.9.4134-4140.2003.
Ali SA, Taj MK, Ali SH. Antimicrobial resistance pattern of bacterial meningitis among patients in Quetta, Pakistan. Infect Drug Resist. 2021; 14: 5107. https://doi.org/10.2147/IDR.S339231.
Assegu Fenta D, Lemma K, Tadele H, Tadesse BT, Derese B. Antimicrobial sensitivity profile and bacterial isolates among suspected pyogenic meningitis patients attending at Hawassa University Hospital: Cross-sectional study. BMC Microbiol. 2020 Dec; 20(1): 1-0. https://doi.org/10.1186/s12866-020-01808-5.
Rasool LM. Prevalence of bacteremia among children complaining different kinds of infections under 12 years old in Baghdad. Baghdad Sci J. 2011; 8(2): 280-285. https://doi.org/10.21123/bsj.2011.8.2.280-285.
Saadi AT, Garjees NA, Rasool AH. Antibiogram profile of septic meningitis among children in Duhok, Iraq. Saudi Med J. 2017 May; 38(5): 517. https://doi.org/10.15537/smj.2017.5.19300.
Jiang H, Su M, Kui L, Huang H, Qiu L, Li L, et al. Prevalence and antibiotic resistance profiles of cerebrospinal fluid pathogens in children with acute bacterial meningitis in Yunnan province, China, 2012-2015. PloS one. 2017 Jun 29; 12(6): e0180161.
Li C, Feng WY, Lin AW, Zheng G, Wang YC, Han YJ, et al. Clinical characteristics and etiology of bacterial meningitis in Chinese children> 28 days of age, January 2014–December 2016: a multicenter retrospective study. Int J Infect Dis. 2018 Sep 1; 74: 47-53. https://doi.org/ 10.1016/j.ijid.2018.06.023.
Abrar S, Hussain S, Khan RA, Ul Ain N, Haider H, Riaz S. Prevalence of extended-spectrum-β-lactamase-producing Enterobacteriaceae: first systematic meta-analysis report from Pakistan. Antimicrob Resist Infect Control. 2018 Dec; 7(1): 1-1. https://doi.org/10.1186/s13756-018-0309-1.
Hassan MM, Belal ES. Antibiotic resistance and virulence genes in enterococcus strains isolated from different hospitals in Saudi Arabia. Biotechnol Biotechnol Equip. 2016 Jul 3; 30(4): 726-32. https://doi.org/10.1080/13102818.
Heydari B, Khalili H, Karimzadeh I, Emadi-Kochak H. Clinical, Paraclinical, and Antimicrobial Resistance Features of Community-Acquired Acute Bacterial Meningitis at a Large Infectious Diseases Ward in Tehran, Iran. Iran J Pharm Res. 2016;15(1):347-54. PMID: 27610176; PMCID: PMC4986127.
Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front immunol. 2018 Apr 13; 9: 1-11. https://doi.org/10.3389/fimmu.2018.0075.
Javadinia S, Tabasi M, Naghdalipour M, Atefi N, Asgarian R, Khezerloo JK, et al. C-reactive protein of cerebrospinal fluid, as a sensitive approach for diagnosis of neonatal meningitis. Afr Health Sci. 2019 Nov 4; 19(3):2372-7. https://doi.org/10.4314/ahs.v19i3.10.
Martinot M, Greigert V, Souply L, Rosolen B, De Briel D, Zadeh MM, et al. Cerebrospinal fluid monocytes in bacterial meningitis, viral meningitis, and neuroborreliosis. Méd Mal Infect. 2018 Jun 1; 48(4):286-90. https://doi.org/10.1016/j.medmal.2018.03.002.
Boskabadi H, Heidari E, Zakerihamidi M. Etiology, clinical findings and laboratory parameters in neonates with acute bacterial meningitis. Iran J Microbiol. 2020 Apr; 12(2):89.
Wang H, Zhu X. Cerebrospinal fluid culture-positive bacterial meningitis increases the risk for neurologic damage among neonates. Ann Med. 2021 Jan 1; 53(1):2201-6. https://doi.org/10.1080/07853890.
Al-Dulaimy HA, Al-Dulaimy WZ, Al-Ani RK. The role of CSF-LDH in early diagnosis of bacterial meningitis. Eurasian J Biosci. 2020; 14(2):7843-6.
Julián-Jiménez A, Morales-Casado MI. Usefulness of blood and cerebrospinal fluid laboratory testing to predict bacterial meningitis in the emergency department. Neurología (English Edition). 2019 Mar 1; 34(2):105-13. https://doi.org/10.1016/j.nrleng.2018.05.005.
Telano LN, Baker S. Physiology, Cerebral Spinal Fluid. National Library of Medicine. StatPearls Publishing; 2022 Jan-. https://www.ncbi.nlm.nih.gov/books/NBK519007/.
Copyright (c) 2023 Baghdad Science Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.