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| ORIGINAL ARTICLE |
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| Year : 1991 | Volume
: 37
| Issue : 2 | Page : 76-8 |
Bacteriological study of meningococcal meningitis.
Vadher PJ, Vaidya NS, Soni P, Kale VV
Department of Microbiology, Kasturba Hospital for Infectitous Diseases, Bombay, Maharashtra.
Correspondence Address:
Department of Microbiology, Kasturba Hospital for Infectitous Diseases, Bombay, Maharashtra.
One hundred and thirty samples of cerebro spinal fluid were collected from patients admitted with suspected signs and symptoms of meningococcal meningitis (M. meningitis) during the period from January 1986 to April 1989 and were processed for gram's staining, cultivation and latex agglutination tests for detection of polysaccharide antigen in the CSF. Totally 41.5% of turbid and hazy spinal fluid were positive for N. meningitidis by smear examination. Only 24.6% were positive by culture but 61.5% of sample were positive by latex agglutination tests. All the strains were sensitive to all antibiotics except one strain which was resistant to penicillin but it was sensitive to rifampicin.
How to cite this article:
Vadher P J, Vaidya N S, Soni P, Kale V V. Bacteriological study of meningococcal meningitis. J Postgrad Med 1991;37:76 |
Meningococcal (M. meningitis) is endemic in India with cases being reported sporadically over the past few years. The disease is characterised by rapid onset, fulminating course in some cases with high morbidity and mortality. In case of sudden outbreak prompt diagnosis of disease is of great significance in starting immediate anti-microbial therapy. The present study was undertaken to find out the incidence of meningococcal meningitis and if there is any increase in incidence in recent months, to study antibiotic sensitivity pattern of N. meningitidis and also to compare role of latex agglutination test (L. A. test) with Gram's stain and culture in rapid diagnosis of M. meningitis.
The samples of cerebrospinal fluid (CSF) were obtained from 130 patients admitted at Kasturba Hospital for Infectious Diseases, Mumbai with suspected signs and symptoms of M. meningitis during the period between Jan. 1986 and Apr. 1989. The CSF samples were examined for the turbidity by visual examination. CSF was centrifuged, examined microscopically by Gram's stain and cultured on chocolate agar medium and organisms were identified by standard method[5] and tested by later agglutination test by using welcogen N. meningitidis ACYW 135 Kits as per method given in the instruction manual.
The antibiotic sensitivity testing was done by disc diffusion method [1]. The following antibiotics penicillin, streptomycin, co-trimoxazole, rifampicin, erythromycin, gentamycin, kanamycin, ampicillin, tetracycline were used.
Although meningococcal disease affects individuals of any age, the highest attack rate is seen in the paediatric age group (54% cases) as seen in [Table - 1]. The present study shows that most cases occurred in the age group 525 years (85%). There were 57 males and 23 females. The incidence seems to be more common in males than females. Out of total 54 CSF samples were turbid, 26 were hazy, and 50 were clear. Only 41.5% of total spinal samples (54/130) examined by Gram's stain were positive for pus cells and intra cellular Gram -ve diplococci indicating N. meningitidis infection. Only 24.6% of samples (32/130) were positive for N. meningitidis by culture but 61.5% of (80/130) hazy and turbid CSF samples were positive for N. meningitidis by L. A. Test [Table - 2] and [Table - 3]. All the strains were sensitive to all the antibiotics except one strain, which was found to be resistant to all antibiotics except rifampicin.
M. meningitis caused by N. meningitidis is a significant cause of morbidity and mortality in developing countries[11]. M. meningitis is endemic throughout the world and epidemic waves of M. Meningitis occur at irregular intervals of several years and last for 2-4 years or longer.
The study shows continuous gradual increase in incidence of M. meningitis since the first case occurred in 1985 and coincided with outbreak in Delhi. Similar increase in incidence has been observed by other workers[8],[12], The study shows incidence of M. meningitis is more common in children (54%) as compared to other age group and children of lower age group still remain a high risk group. Taneja et al[11] and Williamson et al[12] reported similar findings. In our study all the isolates except one were antibiotic except rifampicin. Further more as per Kumari et al[8] and Williamson et al[12] all the isolates continue to be sensitive to the most of rountinely used antibiotics.
In the present study N. meningitidis could be demonstrated by Gram's stain in 41.5% of CSF samples while 24.6% of the samples were positive for N. meningitidis by culture. The low viability of organisms by culture could be due to prior antimicrobial therapy and high and humid temperature prevailing in our country collection and transport. We suggest the yield of organisms could be improved by the bed side inoculation of CSF samples on appropriate media. Burans et al[3] in their study demonstrated N. meningitidis by Gram's stain in 54.5% of CSF samples and in 32% by culture. Ichpujani et al[6] demonstrated organisms by Gram's stain in 70% and by culture in 23% of samples. Bhave et al[2] detected N. meningitidis by smear and culture in 27% of cases only.
In the present study, N. meningitidis could be demonstrated by L. A. Test in 61.5% of CSF samples. Severin et al[10] in their study demonstrated soluble polysacharide in 95.5% of cases by L. A. Test. In another study[4], L. A. test was found to be positive in 75% of cases. High specificity and sensitivity has also been highlighted in another study[7],[9]. Burans et al[3] and Ichpujani et al [6] detected N. meningitidis in 23% and 25.5% of their cases by L. A. test respectively. In the present study as well as in the study of Ichpujani et al[6] there were no false positive reactions. Severin et al[6] in their study observed false positive reactions in 4.5% of cases (2/45).
Though Gram's staining gives better results than culture, during the outbreak the diagnosis cannot be relied on Gram's stain and culture alone as the prior anti-microbial therapy alters the Gram's stain and culture results. Hence recently developed rapid immunological techniques like L. A. test is to be used for better results. The soluble polysacharide present in CSF samples can be detected by L. A. test within a few minutes after the withdrawal of fluid. Thus the L. A. test constitutes a sensitive and reliable method for rapid, simple diagnosis of M. meningitis, but high cost and non-availability of kits are two major constraints for their regular usage in developing countries.
The authors wish to thank the Medical Superintendent, Kasturba Hospital for Infectious Diseases, Mumbai, for allowing us to publish the paper.
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