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| Year : 1986 | Volume
: 32
| Issue : 1 | Page : 24-6 |
Outbreak of meningitis due to Neisseria meningitidis--a microbiological profile.
Bhave GG, Gaikwad SS
How to cite this article:
Bhave G G, Gaikwad S S. Outbreak of meningitis due to Neisseria meningitidis--a microbiological profile. J Postgrad Med 1986;32:24 |
Between February, 1985, and April, 1985, there was an outbreak of meningitis in K.E.M. Hospital, Bombay. Though various workers[3],[4],[7] abroad have reported outbreaks of meningitis due to Neisseria meningitidis, such outbreak has not been reported from India. We, therefore present data of bacteriological and immunological studies conducted during this outbreak.
The study included all CSF samples sent to the Microbiology Laboratory at K.E.M. Hospital, Bombay during February to April, 1985. CSF samples were processed following standard procedures.10 Briefly, the CSF samples were centrifuged at 3,000 rpm for 10 minutes. The supernatants were transferred to sterile test tube and processed for immunological studies. The deposits were streaked onto blood agar, chocolate agar and Mac-Conkey agar plates and smears were prepared, which were stained by Gram's stain. The blood agar and chocolate agar plates were kept in a candle jar and all plates were incubated at 37°C for 24 hours. Smears were made from plates showing growth. Colonies showing Gram negative diplococci were innoculated into sugar viz. glucose, maltose and lactose, an oxidase test was performed and the strains were streaked onto nutrient agar plates which were incubated at 22°C. The strains, which were oxidase positive, fermented only glucose and maltose, failed to grow on nutrient agar plate at 22°C, were reported as Neisseria meningitidis. Antibiotic disc susceptibility test was done by Kirby-Bauer method.[2] As disc method is generally not regarded satisfactory, minimum inhibitory concentration (MIC) of sulphadiazine was determined using Abbot's agar dilution technique.[1] CSF sent for immunological test was processed for counterimmunoelectrophoresis (CIEP) and latex agglutination test (LAT) for detection of meningococcal antigen. The CIEP was done using polyvalent N. meningitidis antisera from Wellcome Research Laboratory, England and LAT was performed using Wellcogen latex agglutination kit with standard positive and negative controls. Case histories of the patients were noted. Patients diagnosed as meningococcal meningitis were transfered to Kasturba Hospital for infectious diseases. Two of the patients whose smear, culture, CIEP and LAT were positive, expired. Blood was not sent for culture to the microbiology laboratory.
Ninety-two CSF samples were sent to the Microbiology laboratory from suspected cases of meningitis in the months of February to April, 1985. In 3 cases, intracellular gram negative diplococci were seen in smear, N. meningitidis was isolated from culture and both CIEP and latex agglutination for N. meningitidis were positive.
In 1 case, smear, culture and LAT were positive but CIEP was negative. In 2 cases, though smear showed intracellular Gram negative diplococci, culture was negative for growth but CSF gave a positive latex agglutination test (CIEP was negative). In 8 cases, though smear, culture and CIEP were negative, the antigen could only be detected by latex agglutination test. The N. meningitidis strains isolated were sensitive to penicillin, chloramphenicol, erythromycin, streptomycin, kanamycin, MIC of sulphadiazine of 3 strains were 6.4 mgm,/L while of 1 strain was 10 mgm/L i.e. all 4 strains were partially resistant to sulphadiazine.
The 14 cases detected during the short 3 months' span of this study, were significantly higher than the usual 2 to 3 cases of meningococcal meningitis reported annually and coincided with the outbreak in Delhi.[6]
Ideally, diagnosis of bacterial meningitis is established by isolation of organism by culture but true incidence in outbreaks may not be obtained if the laboratory diagnosis is based only on isolation of organism by standard smear and culture technique, as previous antibiotic therapy alter the Gram stain and culture results. Recently developed techniques like detection of N. meningitidis capsular antigen in CSF by latex agglutination test has successfully been employed by various workers[5],[6],[7],[8],[9] and complement the routine methods; hence true incidence of infection can be recorded. In our study, we could detect only 4 cases by smear and culture though all 14 cases were detected using Wellcogen latex agglutination kits, thereby highlighting the vital role of immunological studies in the rapid diagnosis of meningitis due to N. meningitidis.
All the 4 strains of N. meningitidis, isoresistant to sulphadiazine. A study of N. meningitidis isolated in Scotland, in 1979 revealed 17.5% of the isolates resistant, and 61.7% partially resistant, to sulphadiazine.[8] Similarly, all the 3 isolates of meningitidis isolated during an outbreak of meningococcal meningitis in Spain, in 1981, were resistant to sulphadiazine.[7] Such an increase in sulphonamide resistance causes concern regarding choice of ideal during for prophylaxis and suggests the need for other drugs like rifampicin.
We are thankful to the Dean, K.E.M. Hospital and Seth G.S. Medical College, Bombay-400 012, for permitting to use the hospital material.
| 1. | Abbot, J. D., Adams, D. and Collins, T. J.: Sensitivity of meningococci to sodium sulphadiazine and six antibiotics. J. Med. Microbiol., 3: 233-241, 1970.  |
| 2. | Bauer, A. W., Kirby, W. M. M., Sherris, J. C. and Turck, M.: Antibiotic susceptibility testing by a standardised single disk method. Amer. J. Clin. Pathol., 45: 493-496, 1966. |
| 3. | DeMayer, S., Seba, J. M., Reginster, G.: Epidemiology of meningococcal meningitis in Belgium. J. Infect. 3 (Suppl. 1): 63-70, 1981. |
| 4. | de Morias, J. S., Munford, R. S., Risi, J. B., Antezana, E. and Feldman, R. A.: Epidemic disease due to serogroup C Neisseria meningitidis in Sao Paulo, Brazil, J. Infect. Dis., 129: 568-571, 1971. |
| 5. | Leinonen, M. and Kayhty, H.: Comparision of countercurrent immunoelectrophoresis, latex agglutination and radio immuno-assay in detection of soluble capsule polysaccharide antigens of Haemophilus influenzae type b and Neisseria meningitidis of group A or C. J. Clin. Pathol., 31: 1172-1176, 1978. |
| 6. | Prakash Kunti: Personal communication, May, 1985. |
| 7. | S'aez-Nieto, J. A., Perucha, M., Casamayor, H., Marcen, J. J., Llacer, A., Garcia-Barreno, B. and Cassal, J.: Out break of infection caused by Neisseria meningitidis group C. type 2 in a nursery. J. Infect., 8: 49-55, 1984. |
| 8. | Sangster, G., Murdoch, J. M. and Gray, J. A.: Bacterial meningitis, 1940-79. J. Infect., 5: 245-255, 1982. |
| 9. | Severin, W. P. J.: Latex agglutination in the diagnosis of meningococcal meningitis. J. Clin. Pathol., 25: 1079-1082, 1972. |
| 10. | Sonnenwirth, A. C.: Collection and culture of specimens and guide for bacterial identification, in, "Gradwohl's Clinical Laboratory Methods and Diagnosis", Editors: A. C. Sonnenwirth. and L. Jarett, the C. V. Mosby Co., St. Louis, Toronto, London, 1980, pp. 1568-1571. |
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