Acute bacterial meningitis in Qatar.

Abstract

OBJECTIVE:

To study the changes in the epidemiology, clinical and bacteriological profiles of bacterial meningitis in the era of the Haemophilus influenzae type b (Hib)vaccine and pneumococcus resistance.

METHODS:

This is a retrospective study of children aged <12 years admitted to the Hamad Medical Corporation, Qatar between January 1998 through December 2002 with positive cerebrospinal fluid culture.

RESULTS:

We described 64 patients with culture proven bacterial meningitis. In infants <3 months (n=29 [45%]), the most common organism was Group B Streptococcus (GBS) (20%). Children >3 months (n=35 [55%]); Hib (25%) and Streptococcus pneumoniae (STP) (20%) were the most common organisms before introduction of Hib vaccination. A significant drop of Hib infections were noticed after introduction of the vaccine. Fever, neck stiffness, seizure, vomiting, and bulging fontanel were the most frequent presenting features. Group B Streptococcus were sensitive to ampicillin and cefotaxime with no resistance detected. Forty percent of STP isolates were resistant to penicillin and 12% were resistant to ceftriaxone. Fifty percent of Hib were resistant to ampicillin; while none of Hib were resistant to ceftriaxone. No case of Listeria monocytogenes meningitis was diagnosed. Morbidity was 28%, and one patient expired (2%) after Klebsiella pneumoniae meningitis. Streptococcus pneumoniae was associated with the highest morbidity (62%) while Hib had zero morbidity in our patients.

CONCLUSION:

Bacterial meningitis is a serious illness with a significant morbidity and mortality. Haemophilus influenzae type b infection decreased which indicated an effective vaccination. As there is 12% bacterial resistance of STP reported against ceftriaxone; We recommend Cefotaxime for infants <3 months while ceftriaxone plus vancomycin as empiric therapy for older patients with community acquired bacterial meningitis. A pneumococcal vaccination may further decrease the incidence of meningitis in our community. A continuos surveillance to detect changes in the microbiology of organisms causing bacterial meningitis or their sensitivity in our community is essential to update these recommendations.

• Authors: Mahmoud F Elsaid, Amina A Flamerzi, Mohammed S Bessisso, Sittana S Elshafie
• Journal: Saudi medical journal (Saudi Med J) Vol. 27 Issue 2 Pg. 198-204 (Feb 2006) ISSN: 0379-5284 [Print] Saudi Arabia
• PMID: 16501676 (Publication Type: Journal Article)

Topics

• Acute Disease
• Child
• Child, Preschool
• Haemophilus Infections (epidemiology)
• Humans
• Infant
• Meningitis, Bacterial (epidemiology)
• Qatar (epidemiology)
• Retrospective Studies
• Streptococcal Infections (epidemiology)