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Clinical Characteristics and Molecular Epidemiology of Children With Meningitis in Tehran, Iran: A Prospective Study Publisher



Pormohammad A1 ; Lashkarbolouki S2 ; Azimi T3, 4 ; Gholizadeh P5 ; Bostanghadiri N1 ; Safari H6 ; Armin S7 ; Mohtavinejad N8 ; Fallah F1
Authors
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Authors Affiliations
  1. 1. Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Department of Biology, Tehran North Branch, Islamic Azad University, Tehran, Iran
  3. 3. Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Medical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
  6. 6. Health Promotion Research Center, school of public health, Iran University of Medical Sciences, Tehran, Iran
  7. 7. Pediatric Infections Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  8. 8. Department of Radio Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

Source: New Microbes and New Infections Published:2019


Abstract

The molecular epidemiology of meningitis in children is unclear in Iran, and data are scarce. We aimed to characterize its clinical and paraclinical features as well as to determine the distribution of genotype/capsular types of common bacterial meningitis agents in children in Iran. All children suspected to have meningitis aged 4 days to 15 years were enrolled onto a prospective cross-sectional study from January 2015 to September 2017. Diagnostic values of clinical features, cerebrospinal fluid and serum parameters were evaluated independently and in combination with each other by multivariate logistic regression to develop a diagnostic rule. Genotype/capsular types of all the isolates were determined by targeting serotype-specific genes with uniplex or multiplex PCR. Among 119 patients suspected of having meningitis, 43 had bacterial meningitis, 19 aseptic and one tuberculous; and there were 56 nonmeningitis cases (NMC). Presentation of four features at the same time—cerebrospinal fluid white blood cell count, protein, polymorphonuclear leukocytes and serum C-reactive protein—revealed 100% sensitivity and 86.4% specificity for diagnosis of bacterial meningitis. Haemophilus influenzae type b (60%), Streptococcus pneumoniae serotype 3 (28.5%) and Neisseria meningitidis B (63.5%) were the most prevalent serotypes. This study demonstrated that a well-designed combination of clinical and paraclinical features is useful, but these combinations are not good enough to be relied on as stand-alone exclusionary tests for the diagnosis of bacterial meningitis. In addition, public immunization of infants with the most prevalent bacterial meningitis serotypes is recommended. © 2019
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