This study was done on the 142 patients suffering from meningitis infection depending on the physician's diagnosis from January 2009 to June 2009. Most specimens was collected in Babylon maternity and children hospital because the age group in this study was (&lt;1-10 years). Blood and CSF specimens were collected, microbiological and biochemical tests were carried. obtained results showed that the most common bacterial causing meningitis was Streptococcus pneumoniae (23.94%) followed by Staphylococcus aureus (16.197%), Neisseria meningitides (14.084%), Escherichia coli (14.084%), Haemophilus influenzae type b (Hib) (11.97%), Pseudomonas aeruginosa (6.338%), Staphylococcus spp. (3.521%) and Acinetobacter spp (1.408%), while Negative Culture formed  (8.45%). Physiological analysis of cerebrospinal fluid in acute bacterial meningitis showed that protein (mg/dl)&gt;500, glucose &lt;40 mg%, CSF/blood glucose &lt;0.4, CRP &gt; 24 mg/L, PMN (%)&gt;80 and white blood cell (cells/mm3) different than normal values indicated of bacterial acute meningitis. Corresponding factors associated with acute bacterial meningitis like sinusitis, cirrhosis, pneumonia, chronic otitis media, diabetes mellitus and malignancy was reported. Age and sex distribution of meningitis causes revealed that the main age group of infection was (&lt;1-5 years) and there is no significant differences between male and female infections. Keywords: Meningitis, Bacteria, Haemophilus influenza, Streptococcus pneumoniae, N. meningitide

Al Taee, Zahraa Mohammad

Al-Janabi, Diyar K.

Al-Marzoqi, Ali Hussein

Hussein, Hussein Jabir

English

International Institute for Science, Technology and Education (IISTE): E-Journals

Journal of Natural Sciences Research                                                                                                         www.iiste.org ISSN 2224-3186 (Paper)   ISSN 2225-0921 (Online) Vol.2, No.9, 2012  75 Prevalence and Physiological analysis of Acute Bacterial Meningitis infections at care center in Babylon province Ali Hussein Al-Marzoqi (Corresponding author) College of Science for women, Babylon University  PO box 435, Al-Hillah city, Babylon, Iraq Tel: 009647710336121 E-mail: ali_almarzoqi@yahoo.co.uk Diyar K. Al-Janabi College of Science, Al-Qadisiyah University  Tel: 009647802599543 E-mail: aljanabidiyar@yahoo.com Zahraa Mohammad Al Taee College of Science, Babylon University Tel: 009647708081699 E-mail: orchedan@yahoo.com Hussein Jabir Hussein College of Science for women, Babylon University  Tel: 009647810109626 E-mail: hass2010feb@yahoo.com  Abstract This study was done on the 142 patients suffering from meningitis infection depending on the physician's diagnosis from January 2009 to June 2009. Most specimens was collected in Babylon maternity and children hospital because the age group in this study was (<1-10 years). Blood and CSF specimens were collected, microbiological and biochemical tests were carried.  obtained results showed that the most common bacterial causing meningitis was Streptococcus pneumoniae (23.94%) followed by Staphylococcus aureus (16.197%), Neisseria meningitides (14.084%), Escherichia coli (14.084%), Haemophilus influenzae type b (Hib) (11.97%), Pseudomonas aeruginosa (6.338%), Staphylococcus spp. (3.521%) and Acinetobacter spp (1.408%), while Negative Culture formed  (8.45%). Physiological analysis of cerebrospinal fluid in acute bacterial meningitis showed that protein (mg/dl)>500, glucose <40 mg%, CSF/blood glucose <0.4, CRP > 24 mg/L, PMN (%)>80 and white blood cell (cells/mm3) different than normal values indicated of bacterial acute meningitis. Corresponding factors associated with acute bacterial meningitis like sinusitis, cirrhosis, pneumonia, chronic otitis media, diabetes mellitus and malignancy was reported. Age and sex distribution of meningitis causes revealed that the main age group of infection was (<1-5 years) and there is no significant differences between male and female infections. Keywords: Meningitis, Bacteria, Haemophilus influenza, Streptococcus pneumoniae, N. meningitides  1. Introduction Acute bacterial meningitis is one of the most severe infectious diseases, causing neurologic sequelae and accounting for an estimated 171,000 deaths worldwide per year [1, 2]. A systematic review of 36 studies from the world's developing nations estimated that there are 126 000 cases of neonatal meningitis annually, with over 50 000 deaths [3]. In these countries the major neonatal pathogens are Gram negative bacilli, such as Escherichia coli and Klebsiella species. A further recent review of almost 30 000 children and adults in 50 studies from 25 African countries found Streptococcus pneumoniae and Haemophilus influenzae type b to be the commonest causes of bacterial meningitis, with Neisseria meningitidis ranked third [4].  Journal of Natural Sciences Research                                                                                                         www.iiste.org ISSN 2224-3186 (Paper)   ISSN 2225-0921 (Online) Vol.2, No.9, 2012  76 Neisseria meningitides is a leading cause of bacterial meningitis and septicemia in children and adolescents in the United States, with attack rates highest among children younger than 2 years of age [5]. The lack of field-based routine laboratory surveillance capacity may contribute to a failure to appreciate the contribution of such agents as Haemophilus influenzae and Streptococcus pneumoniae, in addition to meningococcal meningitis, to the overall burden of meningitis [6]. 2. Materials and Methods: Culture from proven or likely significant meningitis infections were collected CSF and Blood specimens in Babylon Maternity and Children Hospital from January 2009 to June 2009. A maximum of 142 isolates each of Streptococcus pneumoniae, Staphylococcus aureus, Neisseria meningitides, Escherichia coli, Haemophilus influenzae type b (Hib), Pseudomonas aeruginosa, Staphylococcus spp. Acinetobacter spp. and Negative  Identification of isolates; the isolates were confirmed the identity and purity of every strain. S. pneumoniae isolates were confirmed by inhibition by optochin we used Chocolate agar and Blood agar for isolation so is used for Neisseria meningitidis. Haemophilus strains were identified by X and V factor requirement and reaction to polyvalent antiserum (Difco Laboratories, USA), and strains were confirmed as H. influenzae by determination of the requirement for both the X and V factors. Others gram negative bacteria diagnosis using specific media and biochemical tests for isolation and differentiation.  Hematological pending was used to determine the Physiological analysis of Cerebrospinal fluid bacterial meningitis. The demographical information submitted for each strain included patient age and gender, specimen collection date and specimen source.  3. Results and Discussion In this study from 142 meningitis cases the most common bacterial causing meningitis was Streptococcus pneumoniae (23.94%) followed by Staphylococcus aureus (16.197%), Neisseria meningitides (14.084%), Escherichia coli (14.084%), Haemophilus influenzae type b (Hib) (11.97%), Pseudomonas aeruginosa (6.338%), Staphylococcus spp. (3.521%) and Acinetobacter spp (1.408%), while Negative Culture formed  (8.45%) as shown in table (1). These results are strongly agreed with Isabelle study that found Streptococcus pneumoniae, Haemophilus influenzae type b (Hib) and Neisseria meningitides was the main causes of meningitis 34%, 27%, 23% respectively [6]. We found that S. pneumoniae caused the majority of cases of adult meningitis and the majority of deaths due to meningitis and that it had an incidence similar to that of N. meningitidis. Although S. pneumoniae causes a high proportion of meningitis in Africa [7, 8].  Pneumococci contribute disproportionately to the burden of meningitis because of the substantially worse outcome associated with pneumococcal disease, compared with that associated with meningococcal disease [7]; moreover, pneumococci are the predominant cause of bacterial pneumonia in the developing world. Our data, if confirmed in other locations, suggest that prevention and treatment may need to focus as much on pneumococcus as on meningococcus. Vaccine recommendations will need to consider that serotype. Cerebrospinal fluid samples collected from by lumbar puncture procedure by specialist. The CSF parameters are shown in Table 2. CSF protein elevated in 83.8% of cases, Glucose <40 mg% was formed 87.3%, CSF/blood glucose <0.4 in 84.5% of all cases, CRP > 24 mg/L was over then 71.8%, PMN (%)>80 was 83.8%. These finding are agreed with Bodin study who found that all these parameters are changes according to bacterial activity [9].  Also other studies revealed that CRP was elevated during neonatal infection [10]. Meningococcal meningitis is endemic in India. There has been a sudden surge of cases of meningococcal meningitis in 2005 in Delhi, so this Present study was undertaken to find out changing trends in physiological parameters [11]. Corresponding factors in acute bacterial meningitis showed below in table 3. It revealed 68.3% from all meningitis cases, these results are correlated with Marc study which found that 59% of meningitis related to physiological and were related to anatomical problems [12].  Other authors report a case of fatal tuberculous meningoencephalitis following chronic bilateral otitis media in a child [13]. Previous studies, as in ours, older age, Sinusitis, Cirrhosis, Diabetes mellitus, and shock on the first day correlate with a poor outcome in patients with meningitis. Other risk factors for death were observed in some studies, notably, diabetes mellitus, seizures, bacteremia, gram-negative bacilli meningitis, CSF WBC more than 5,000 cells/mm3 [14, 15]. Table 4 shows the most important clinical features of meningitis infection. Other study found the same clinical Journal of Natural Sciences Research                                                                                                         www.iiste.org ISSN 2224-3186 (Paper)   ISSN 2225-0921 (Online) Vol.2, No.9, 2012  77 features including, Fever was observed mosy cases, and all but one were in a state of disturbed consciousness. Hydrocephalus was seen in many patients. Seizure occurred in 10, nine of whom had generalized seizures and one, a focal seizure. The other clinical manifestations included cranial nerve involvement, and neck stiffness is recorded [16].  Other study found the same finding including Fever, Vomiting, Headache, Convulsions with nearly agreed percents [17]. Table 5 clear the relation between age and gender distribution and frequency of meningitis causes isolated from patients. Higher percent of meningitis infection was between (<1-5 years). Bacterial meningitis remains a major cause of morbidity, mortality and neurodisability in childhood, particularly in the developing world where effective vaccines against the usual pathogens responsible for the disease are not in routine use. Nigerian study found that the main age group of infection ranged between 2 months and 12 years [18]. Other study agreed with this results of cases of pneumococcal meningitis and N. meningitidis meningitis, 71% occurred among persons below12 years of age [6]. Streptococcus pneumoniae showed a remarkable sensitivity, Gentamycin, Kanamycin, Lincomycin, Nitrofurantoin, Norfloxacin, Oxacillin, Ofloxacin, Oxytetracyclin, Rifampim, while Haemophilus influenzae have sensitivity to Ofloxacin. Staphylococcus aureus sensitive to Norfloxacin and  Nitrofurantoin (6). These results were agreed with [19,20].  E. coli isolates showed sensitivity with Nitrofurantoin, Ofloxacin, Norfloxacin and Pseudomonas aeruginosa shows sensitivity with Norfloxacin, Ofloxacin, Piperacillin,   it is nearly compatible with Indian, Taiwan, Spain, and Senegal isolates [21,22].  In this study E. coli, Pseudomonas aeruginosa, isolates are resistant against many antibiotics. Whereas, this drug exhibited low resistance rate in the major part of the world, despite of it's being used for many years [23]. This is probably due to the fact that this antibiotic has been widely used in treating meningitis over the past decade in this region [24].  References World Health Organization. World health report. 2000 [cited 2008May 1]. Available from http://www.who.int/whr/2000/en/index. html Jodar L, Feavers I.M, Salisbury, D. Granoff, D.M. Development of vaccines against meningococcal disease. Lancet. 2002; 359:1499– 508. DOI: 10.1016/S0140-6736(02)08416-7 Stoll, B.J. the global impact of neonatal infection. Clinic. Perinatol. 1997; 24. 1-24. Peltola, H. Burden of meningitis and other severe bacterial infections of children in Africa: implications for prevention. Clin. Infect. Dis. 2001; 31:64- 75. Colin, W. Shepard, M.D, Nancy, E. Rosenstein, M. Marc, F. Neonatal meningococcal disease in the United States, 1990 to 1999. Pediatr.Infect. Dis.J., 2003; Vol. 22, No. 5:418–22. Isabelle, P. du Chatelet, Y.  Bradford, D. Gessner, A. Antignac, B. Naccro, B. Njanpop-Lafourcade, Macaire S. Ouedraogo, Sylvestre R. Tiendrebeogo, Emmanuelle Varon, and Muhammed K. Taha . Bacterial Meningitis in Burkina Faso: Surveillance Using Field-Based Polymerase Chain Reaction Testing. Clinical Infectious Diseases 2005; 40:17–25. Gordon,  S.B. Walsh, A.L. Chaponda, M. Bacterial meningitis in Meningitis Surveillance in Burkina Faso • CID 2005:40 (1 January) .25 Malawian adults: pneumococcal disease is common, severe, and seasonal. Clin Infect Dis 2000; 31:53–7. 35.  Theodoridou, M.N. Vasilopoulou, V.A. Atsali, E.E. Pangalis, A.M. Mostrou, G.J. Syriopoulou, V.P. Hadjichristodoulou, C.S. Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period. BMC Infect Dis. 2007 Aug 30;7:101.  Bodin, K. Pantip, C. and Alan G. Acute bacterial meningitis in adults : A 20 year review. southeast asain J Trop Med public health. December 2004. Vol 35 No. 4.p.886. Simon, L. Gauvin, F. Amre, D.K. Saint-Louis, P. Lacroix, J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2005 May Journal of Natural Sciences Research                                                                                                         www.iiste.org ISSN 2224-3186 (Paper)   ISSN 2225-0921 (Online) Vol.2, No.9, 2012  78 1;40(9):1372-3; author reply 1373-4. Kumar, S. Kashyap, B. Bhalla, P. The rise and fall of epidemic Neisseria meningitidis from a tertiary care hospital in Delhi, January 2005-June 2007.Trop Doct. 2008 Oct;38(4):222-4. Marc, T. and Nigel C. Epidemiology, Etiology, Pathogenesis, and Diagnosis of Recurrent Bacterial Meningitis. Clinical Microbiology Reviews, July 2008, p. 519-537, Vol. 21, No. 3. Gody, J.C.  Kassa-Kelembho, E. Bobossi-Serengbe, G. Beyam, E.N. Bercion, R. A. case of tuberculous otitis media associated with meningoencephalitis in the Bangui paediatric institution.  Med Mal Infect. 2006 Mar;36(3):177-9. Aronin, S.I. Peduzzi. P. Quagliarello, V.J. Community acquired bacterial meningitis: risk stratification for adverse clinical outcome and effect of antibiotic timing. Ann Intern Med 1998; 129: 862-9.  Tang, L.M. Chen, S.T. Hsu, W.C. Lyu, R.K. Acute bacterial meningitis in adults: a hospital base epidemiological study. Q J Med 1999; 92: 719-25.  Chang, C. J. Chang, W. N. Huang, L. T. Chang,Y. C. Huang, S. C. Hung, P. L. Ho, H. H. Chang, C. S. Wang, K. W. Cheng, B. C. Lui, C. C. Chang, H. W. and Lu, C. H. Cerebral infarction in perinatal and childhood bacterial meningitis. Q J Med 2003; 96:755–762. Adewale, A.O. Laditan, Isaac, Odame, Oluyinka Ogundipe. CHILDHOOD MENINGITIS AT KING FAHAD HOSPITAL, HOFUF, SAUDI ARABIA. Annals of Saudi Medicine, 1997. Vol 17, No 6. Lagunju, I.A. Falade, A.G. Akinbami, F.O. Adegbola, R. Bakare, R.A. Childhood bacterial meningitis in Ibadan, Nigeria--antibiotic sensitivity pattern of pathogens, prognostic indices and outcome. Afr J Med Med Sci. 2008 Jun;37(2):185-91. Joice, N. R.  Josilene, B.L.  Guilherme, S.R. Soraia, M.C. Ka´tia, S. Mitermayer, G. R. and Albert, I. K. (Nov. 2002). Antimicrobial Resistance in Haemophilus influenzae Isolated during Population-Based Surveillance for Meningitis in Salvador, Brazil. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, p. 3641–3643. Isis, T. Kiomy, F.  Alina, L.  Jesús, O. and José Campos. (2003). High levels of multiple antibiotic resistance among 938 Haemophilus influenzae type b meningitis isolates from Cuba (1990–2002). Journal of Antimicrobial Chemotherapy Vol. 52, p: 695–698. Dromigny, J.A.  Nabeth, P. Perrier, Gros, C. J.D. Distrinution and susceptibility of bacterial urinary tract infections in Dakar, Senegal. Int J Antimicrob Agents 2002, 20:339-347.  Colodner, R. Keness, Y. Chazan, B. Raz, R. Antimicrobial susceptibility of community-acquired uropathogens in northern Spain. Int J Antimicrob Agents 2001, 18:189-192.  Honderlick, P. Cahen, P. Gravisse , J.  Vignon, D. Uncomplicated urinary tract nfections, what about fosfomycin and Nitrofurantoin in 2006. Pathol Biol 006, 54:462-6. Hillier, S.L. Magee, J.T. Howard, A.J. Palmer, S.R. How strong is the evidence that antibiotic use is risk factor for antibiotic-resistant, community -acquired urinary tract infection. J Antimicrob Chemother 2002, 50:241-247.  Journal of Natural Sciences Research                                                                                                         www.iiste.org ISSN 2224-3186 (Paper)   ISSN 2225-0921 (Online) Vol.2, No.9, 2012  79 Table1: Percentage of Etiological agents causes meningitis. Etiological agents causes meningitis No. % Streptococcus pneumoniae 34 23.943 Staphylococcus aureus 23 16.197 Neisseria meningitidis 20 14.084 Escherichia coli 20 14.084 Haemophilus influenzae type b (Hib) 17 11.97 Pseudomonas aeruginosa 9 6.338 Staphylococcus spp. 5 3.521 Acinetobacter spp 2 1.408 Negative Culture 12 8.450 Total 142 100   Table2: Physiological analysis of Cerebrospinal fluid in acute bacterial meningitis Etiological agents causes meningitis  No. Cerebrospinal fluid analysis in acute bacterial meningitis Protein (mg/dl)>500 Glucose <40 mg% CSF/blood glucose <0.4 CRP > 24 mg/L PMN (%)>80 White blood cell (cells/mm3) Streptococcus pneumoniae 34 28 30 26 26 30 27 Staphylococcus aureus 23 20 22 22 19 21 20 Neisseria meningitidis 20 18 18 20 16 18 20 Escherichia coli 20 16 20 19 18 20 14 Haemophilus influenzae type b (Hib) 17 15 11 16 13 15 14 Pseudomonas aeruginosa 9 9 5 9 3 4 7 Staphylococcus spp. 5 5 2 4 4 3 4 Acinetobacter spp 2 2 1 1 1 1 2 Negative Culture  12 6 2 3 2 7 4 Total 142 119 (83.8%) 124 (87.3%) 120   (84.5%) 102 (71.8%) 119  (83.8) 112  (78.8)  Journal of Natural Sciences Research                                                                                                         www.iiste.org ISSN 2224-3186 (Paper)   ISSN 2225-0921 (Online) Vol.2, No.9, 2012  80 Table 3: Corresponding factors in acute bacterial meningitis Factors Meningitis 142 episodes % Sinusitis 15 10.5 Cirrhosis 20 14 Pneumonia 11 7.7 Chronic Otitis media 25 17.6 Diabetes mellitus 22 15.5 Malignancy 4 2.8 Total  97 68.3  Table 4: Clinical finding of bacterial meningitis. Factors Meningitis 142 episodes % Seizure 52 36.6 Neck stiffness 63 44.4 Fever 102 71.8 Vomiting 86 60.6 Shock 55 38.7  Table 5: Age and gender distribution and frequency of meningitis causes isolated from patients. Streptococcus pneumoniae Staphylococcus aureus Neisseria meningitidis Escherichia coli Haemophilus influenzae type b Pseudomonas aeruginosa Staphylococcus spp. Acinetobacter spp Negative Culture  Age Groups (Years) Female  Male Female  Male Female  Male Female  Male Female  Male Female  Male Female  Male Female  Male Female  Male 6 8 4 5 5 3 6 0 5 0 1 0 0 1 1 1 5 3 <1 6 5 4 1 2 1 1 3 0 7 0 3 0 0 0 0 2  (1-3) 1 0 2  1 3 1 0 1 0 2 0 2 0 0 0 0 0 (4-5) 3 1 1 2 2 0 3 2 1 0 0 1 0 0 0 0 0 1 (6-7) 2 1 1 0 1 0 1 0 0 2 1  0 1 0 0 0 0 (8-9) 1 0 2 0 2 0 1 2 1 0 0 1 0 1 0 0 1 0 (10-11) 34 22 20 20 17 9 5 2 12 Total   Journal of Natural Sciences Research                                                                                                         www.iiste.org ISSN 2224-3186 (Paper)   ISSN 2225-0921 (Online) Vol.2, No.9, 2012  81 Table 6: Antimicrobial sensitivity and spectrum for 13 selected antimicrobial agents tested against most frequently occurring meningitis infection pathogens. Microorganism Antimicrobial agent / % sensitive strains E CN K L ME F NOR OFX OX T P PRL RA Streptococcus pneumoniae R s s s R s s s s s R R s Staphylococcus aureus R R R R R s s R R s R R R Haemophilus influenzae R R R R R R R s R R R R R Staphylococcus spp. R R R R R s s R R R R R R Escherichia  coli R R R R R s s s R R R R R Pseudomonas aeruginosa R R R R R R s s R R R s R Neisseria meningitidis R s s R R R s R R R s R R Acinetobacter spp R s s R R s s R s R s s R E \Erythromycin, CN\Gentamycin, K\Kanamycin, L\Lincomycin, ME\Methicillin, F\Nitrofurantoin, NOR\Norfloxacin, OFX \Ofloxacin, OX\Oxacillin, T\Oxytetracyclin, P\Penicillin  G, PRL \Piperacillin, RA\Rifampim.     

Prevalence and Physiological analysis of Acute Bacterial Meningitis infections at care center in Babylon province

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Prevalence and Physiological analysis of Acute Bacterial Meningitis infections at care center in Babylon province

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