Streptococcus pneumoniae Serotype-2 Childhood Meningitis in Bangladesh: A Newly Recognized Pneumococcal Infection Threat

Abstract

Background Streptococcus pneumonia e is a leading cause of meningitis in countries where pneumococcal conjugate vaccines (PCV) targeting commonly occurring serotypes are not routinely used. However, effectiveness of PCV would be jeopardized by emergence of invasive pneumococcal diseases (IPD) caused by serotypes which are not included in PCV. Systematic hospital based surveillance in Bangladesh was established and progressively improved to determine the pathogens causing childhood sepsis and meningitis. This also provided the foundation for determining the spectrum of serotypes causing IPD. This article reports an unprecedented upsurge of serotype 2, an uncommon pneumococcal serotype, without any known intervention. Methods and Findings Cases with suspected IPD had blood or cerebrospinal fluid (CSF) collected from the beginning of 2001 till 2009. Pneumococcal serotypes were determined by capsular swelling of isolates or PCR of culture-negative CSF specimens. Multicenter national surveillance, expanded from 2004, identified 45,437 patients with suspected bacteremia who were blood cultured and 10,618 suspected meningitis cases who had a lumber puncture. Pneumococcus accounted for 230 culture positive cases of meningitis in children <5 years. Serotype-2 was the leading cause of pneumococcal meningitis, accounting for 20.4% (45/221; 95% CI 15%–26%) of cases. Ninety eight percent (45/46) of these serotype-2 strains were isolated from meningitis cases, yielding the highest serotype-specific odds ratio for meningitis (29.6; 95% CI 3.4–256.3). The serotype-2 strains had three closely related pulsed field gel electrophoresis types. Conclusions S. pneumoniae serotype-2 was found to possess an unusually high potential for causing meningitis and was the leading serotype-specific cause of childhood meningitis in Bangladesh over the past decade. Persisting disease occurrence or progressive spread would represent a major potential infection threat since serotype-2 is not included in PCVs currently licensed or under development.

Epidemiology of Invasive Pneumococcal Disease in Bangladeshi Children Before Introduction of Pneumococcal Conjugate Vaccine

“…22 Pneumococcal isolates from blood and CSF were serotyped by Quellung method as described previously. 6,23 PCR-based serotyping 11,24 was performed on available residual CSF specimens from culture-negative meningitis cases that were determined to be pneumococcal by Binax or PCR. In brief, extracted DNA from culture-negative CSF specimens was subjected to sequential multiplex PCR.…”

“…A total of 38 primers were customized for multiplexing in 9 different reactions, based on the prevalence of serotypes. 11,24 All isolates (2007-2013) and culture-negative cases (2011-2013) of serogroup 6 were screened for 6A, 6B, 6C and 6D by specific antisera and PCR, respectively. [25][26][27] However, serotypes within serogroup 18 and 6, detected by PCR of culture-negative CSF specimens collected during 2007-2010, could not be differentiated.…”

Determinants of antibiotic prescription in paediatric patients: The case of two hospitals in Maputo, Mozambique

“…[1,2] These and other childhood diseases can be caused by different pathogens including viruses, bacteria, fungi and protozoa and identifying the aetiological agents to establish the appropriate therapeutic approach is essential. [3][4][5][6] According to van Buul et al, [7] a physician's decision to use antibiotics is guided by six factors: the patient's clinical condition, advance care plans, using diagnostic resources, physician-perceived risks, the influence of family members, and the influence of the environment. Good prescription practice relies on determining the infection aetiology.…”

Monoclonal antibodies in immunodiagnostic assays: a review of recent applications

“…A novel WB was developed based on mAbs for the detection of cytomegalovirus in latently infected blood donors, pregnant women, and transplant recipients with ongoing human cytomegalovirus (HCMV). Evaluation of this assay revealed high sensitivity and specificity compared to the conventional IgM based ELISA (Lazzarotto et al, 1997) One of the major bacterial pathogens that causes morbidity and mortality in young, elderly and immunocompomised persons worldwide is pneumococcal infections (Saha et al, 2012). It is caused by Streptococcus pneumoniae that is composed of about 90 serotypes, based on their carbohydrate capsule (Henrichsen, 1995).…”