Etiology of Meningitis from Patients Suspected of Meningitis Attending Tribhuvan University Teaching Hospital, Kathmandu, Nepal

Abstract

Meningitis is an inflammatory infection of the membranes surrounding the brain and spinal cord, which occurs either as a primary disease or secondarily to disease in some other parts of the body. Its most frequent causes are Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae. The epidemiological trend of acute meningitis varies with time and geography. Information on the relative frequency of the isolation and antibiotic susceptibility patterns of these pathogens is scarce in Nepal. To analyze the various causative agents of meningitis in all age group patients and to know the antimicrobial susceptibility pattern of bacterial isolates from the Cerebrospinal Fluids (CSF) of suspected cases of meningitis, were the prime objectives of this paper. In this cross sectional study, a total 356 CSF specimens were collected from patients suspected of meningitis and processed macroscopically, microscopically and microbiologically by standard microbiological methods in Emergency Laboratory of Tribhuvan University Teaching Hospital (TUTH) Kathmandu, Nepal over a period of six months, from March to August 2014. Out of 356 CSF samples, 16(4.5%) were found to be culture positive. Among the culture positive isolates, the most common bacterial isolate was Staphylococcus aureus, 4(25%). Isolation rate of Cryptococcus neoformans, the only fungal etiology of meningitis, was 3(18.8%), which was seen in elderly patients indicating increased susceptibility of C. neoformans in immune-compromised status of patients. All bacterial isolates were found to be sensitive to Chloramphenicol. The isolation rate of pathogens causing meningitis from CSF is low (4.5%). Chloramphenicol may be used for the treatment of bacterial meningitis.

Detection of Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae in Culture Negative Cerebrospinal Fluid Samples from Meningitis Patients Using a Multiplex Polymerase Chain Reaction in Nepal

“…S. pneumoniae , N. meningitidis and H. influenzae were the most commonly reported isolates from bacterial meningitis cases in this study and similar other reports from Nepal [ 19 , 20 , 21 , 22 , 23 ]. Furthermore, meningitis caused by these bacteria are vaccine preventable.…”

Cryptococcal meningitis in people living with human immunodeficiency virus in Nepal: Perspectives from resource limited setting

“…A relatively lower prevalence (2%–2.4%) of cryptococcal meningitis was reported by some researchers of our region 17–19 . Few studies in Nepal have reported cryptococcal meningitis in non‐HIV cases associated with other conditions like liver diseases and prolonged steroid therapy 17,20,21 . However, the proportion of cryptococcal meningitis in PLHIV is higher than in non‐HIV cases.…”

“…[17][18][19] Few studies in Nepal have reported cryptococcal meningitis in non-HIV cases associated with other conditions like liver diseases and prolonged steroid therapy. 17,20,21 However, the proportion of cryptococcal meningitis in PLHIV is higher than in non-HIV cases. This might be due to suppression of cell-mediated immunity in PLHIV, which predisposes them for opportunistic infections.…”