Are Pathogenic Leptospira a Possible Cause of Aseptic Meningitis in Suspected Children in Sudan?

Abstract

Introduction Clinical presentations of leptospirosis are diverse, with meningitis easily confused with other microbial causes. We aimed to investigate the involvement of pathogenic leptospira in the cerebrospinal fluid (CSF) of meningitis-suspected children in Sudan. Methods A total of 153 CSF specimens were collected over 5 months from patients attending a reference pediatric hospital in Omdurman, Sudan. All patients had provisionally been diagnosed with meningitis on admission. Demographic, clinical, and conventional laboratory findings were obtained. DNA was extracted using a QIAamp mini kit, and the secY gene investigated using real-time PCR. Results Nine of 153 (6%) CSF specimens were positive for pathogenic leptospiral DNA. All these patients were male (seven infants and two toddlers aged ˂4 years). Typical conventional laboratory findings for aseptic meningitis (ie, CSF turbidity/pleocytosis, normal or reduced CSF glucose, normal or elevated proteins) were seen in five (56%). All patients presented with fever and seizures, 56% vomiting and stiff neck, and 29% bulging fontanel. Most (67%) patients presented in summer (March to May). Polymicrobial infections were identified in three patients (33%). Conclusion We conclude that pathogenic leptospira are probably a common cause of meningitis in children in Sudan; therefore, we recommend including leptospirosis in the differential diagnosis of CNS infections and other undifferentiated febrile illnesses in this country.

Viral meningitis in Sudanese children: Differentiation, etiology and review of literature

“…The overall clinical, nucleic acids and conventional microbial findings are illustrated in Figure 1 which describes findings from this study alongside findings reported in our other publications. [17,20,21]…”

“…[20] § This number is the sum of 18 cases with level-1 of diagnostic certainty for aseptic meningitis along with 16 cases with laboratory evidence of non-cultivable microbial etiology (further information is presented in our previous publications. [21,22] ‖ Four cases with confirmed HSV-1 and HEV DNA/RNA and 12 cases with other confirmed viral nucleic acids (this information is presented in our previous publication. [21] by PCR initial activation step necessary for HotStarTaq ® DNA Polymerase (Qiagen ® , Hilden, Germany) at 95°C for 10 minutes, then denaturation at 94°C for 15 seconds and combined annealing and extension at 60°C for 60 seconds.…”

“…[21,22] ‖ Four cases with confirmed HSV-1 and HEV DNA/RNA and 12 cases with other confirmed viral nucleic acids (this information is presented in our previous publication. [21] by PCR initial activation step necessary for HotStarTaq ® DNA Polymerase (Qiagen ® , Hilden, Germany) at 95°C for 10 minutes, then denaturation at 94°C for 15 seconds and combined annealing and extension at 60°C for 60 seconds. This cycle was repeated 45 times.…”

“…Negative reverse transcriptase preparation is a mixture containing cDNA PCR component with the exception of RNA template (replaced by RNase-free ddH 2 O) and was subjected to the same cDNA PCR conditions. Non-template control is a qPCR preparation in which template DNA is replaced by RNase-free ddH 2 O. Real-time cycler thermal conditions were similar for all 4 PCRs; heating at 50°C for 2 minutes (for carryover prevention since UNG will eliminate any dUMP-containing PCR products resulting from carryover contamination), followed This number is the sum of 17 cases with positive microbial origin -but with normal cellular count-along with 23 cases with CSF pleocytosis with or without positive microbial etiology (this is the overall project findings described in 4 articles -including this one [20,21,22] ). ‡ This information is presented in detail in our previous publication.…”

A Cross Sectional Study on the Bidirectional Interactions Between Leptospirosis and HIV Infection Among Patients from Maputo Central Hospital, Mozambique

“…9 In about 10% of patients infected with pathogenic serovars, the symptoms may progress to fulminant leptospirosis, known as Weil's disease, characterized by multiorgan dysfunction with pulmonary hemorrhage, renal and liver impairment. 10,20 In children the disease is also associated with meningitis 21 and case fatality rates for severe disease range from 10% to 30%. 17,[22][23][24] Studies of bidirectional interactions between Leptospira infection and HIV are scarce worldwide, especially from sub-Saharan Africa.…”