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   Table of Contents     
LETTER TO EDITOR  
Year : 2017  |  Volume : 9  |  Issue : 1  |  Page : 35-36
CNS infections in children: Experience from a tertiary care center


1 Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Paediatrics, Christian Medical College, Vellore, Tamil Nadu, India
3 Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

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Date of Web Publication13-Feb-2017
 

How to cite this article:
Subashini B, Adhikari DD, Verghese VP, Jeyaseelan V, Veeraraghavan B, Prakash JA. CNS infections in children: Experience from a tertiary care center. J Global Infect Dis 2017;9:35-6

How to cite this URL:
Subashini B, Adhikari DD, Verghese VP, Jeyaseelan V, Veeraraghavan B, Prakash JA. CNS infections in children: Experience from a tertiary care center. J Global Infect Dis [serial online] 2017 [cited 2017 Mar 29];9:35-6. Available from: http://www.jgid.org/text.asp?2017/9/1/35/194375


Sir,

Bacterial meningitis is associated with high mortality and morbidity, especially in children. Most common pathogens causing bacterial meningitis in children are Haemophilus influenzae type B (Hib) and Streptococcus pneumoniae, accounting for up to 75% of cases.[1] From March 2010 to April 2011, 400 children between 0 and 15 years old with symptoms of acute central nervous system (CNS) infection were screened, of which 54 who had cerebrospinal fluid (CSF) white blood cell count ≥10 cells/µl were recruited while those with history of road traffic accidents, CNS anomalies, and postoperative meningitis were excluded.

Conventional CSF culture, BacT/ALERT for CSF, latex agglutination, and conventional polymerase chain reaction (PCR) to detect the capsular polysaccharide gene of S. pneumoniae and TaqMan real-time PCR to detect the bcs B gene of Hib were performed with the sequences of the primers and PCR protocol described by Pai et al.[2] and Mayer,[3] respectively.

Fever was observed in 90% of children, vomiting and seizures in 51% of children. In 23 of the 54 children, a cause of CNS infection could be established. Thirteen (24%) of the 54 children were confirmed to have pyogenic bacterial meningitis, with eight due to S. pneumoniae, four due to Hib, and one case of Streptococcus pyogenes meningitis was detected by BacT/ALERT culture.

Culture, PCR, and latex agglutination detected five cases of S. pneumoniae and one case of Hib, whereas six cases were detected by nonculture methods, three pneumococcal meningitis by PCR only, one Hib meningitis by PCR and LA, and one case by LA alone. Spike and dilution tests performed on this sample ruled out PCR inhibitor; this was considered a false negative PCR test. Studies have shown that non culture methods have performed better, as demonstrated by Kennedy et al.[4]

In the 41 children who did not fit in the pyogenic group, three children were diagnosed as tuberculous meningitis based on a standard case definition and response to anti-tuberculosis treatment, four as rickettsial meningitis with Weil-Felix test positive along with the presence of eschar in three of them and all four showing dramatic response to doxycycline, three children as neurocysticercosis by standard diagnostic criteria including computed tomography scans showing typical ring-enhancing lesions. Interestingly, at 6 months follow-up, sequelae were seen in children who did not have a definite diagnosis; this reiterates that identification of the agent leads to effective treatment which reduces mortality and morbidity.[5]

In conclusion, culture and nonculture methods including radiological methods are necessary for the diagnosis of meningitis. This study reiterates the need for a battery of tests for the detection of these etiological agents causing CNS infections. Further studies to identify other etiological agents, especially viral causes need to be evaluated to diagnose meningitis in children.

Acknowledgments

We acknowledge Dr. Maria Carvalho and Dr. Leonard W. Mayer, Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Centre of Immunization and Respiratory Diseases, Centre for Disease, Atlanta, GA, USA, for providing the protocol and reagents for PCR.

Financial support and sponsorship

Fluid Research Grant of Christian Medical College, Vellore.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev 2010;23:467-92.  Back to cited text no. 1
    
2.
Pai R, Gertz RE, Beall B. Sequential multiplex PCR approach for determining capsular serotypes of Streptococcus pneumoniae isolates. J Clin Microbiol 2006;44:124-31.  Back to cited text no. 2
    
3.
Mayer L. PCR for detection and characterization of bacterial meningitis pathogens: Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae. In: Laboratory Methods for the Diagnosis of Meningitis. 2nd ed. Geneva: WHO; 2011. p. 105-56.  Back to cited text no. 3
    
4.
Kennedy WA, Chang SJ, Purdy K, LE T, Kilgore PE, Kim JS, et al. Incidence of bacterial meningitis in Asia using enhanced CSF testing: Polymerase chain reaction, latex agglutination and culture. Epidemiol Infect 2007;135:1217-26.  Back to cited text no. 4
    
5.
Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I. Global and regional risk of disabling sequelae from bacterial meningitis: A systematic review and meta-analysis. Lancet Infect Dis 2010;10:317-28.  Back to cited text no. 5
    

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Correspondence Address:
John Antony Jude Prakash
Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.194375

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008