Title : Culture-proven acute bacterial meningitis and PCR-proven acute viral meningitis in children at tertiary hospital in Oman: 10-year experience
Background: Acute meningitis is an inflammation of the tissue surrounding the brain, commonly caused by viruses and bacteria. The typical clinical manifestations of acute meningitis include fever, headache, neck stiffness and change in mental status 5,8. The diagnosis is made by attaining a positive cerebrospinal fluid (CSF) culture or detection of bacterial or viral material by polymerase chain reaction (PCR) in CSF sample 3.
Methodology: This is a retrospective review of all children with laboratory-confirmed acute meningitis managed at the child health department at Sultan Qaboos University Hospital, Muscat, Oman, during a 10-year period between January 2008 and December 2018. All positive cerebrospinal fluids during the study period were identified from the laboratory electronic database through the hospital information system (HIS).
Results: The commonest causative organism of bacterial meningitis in children less than 13 years of age in our study was GBS (5 cases) followed by Escherichia coli (4 cases) and 3 cases of H.influenzae. Viral meningitis reported enterovirus was isolated in 20 cases (90.9%) then 1 case of parechovirus and 1 case of Epstein bar virus. Commonest empirical antibiotics prescribed was one of the 3rd generations cephalosporins in 84.6% (33 patients) of the study population. Vancomycin was combined in 18 cases. Head ultrasound was requested for 9 cases, head CT was done for 10 cases and brain MRI was done for 10 cases of bacterial meningitis. Regular follow up was scheduled for (51%) of the study population after discharge. Mean period of 6 months was for 19 cases of bacterial meningitis and a case of viral meningitis that was followed up for 24 months. Bilateral hearing loss of 50 dB was reported for 1 case with GBS-bacterial meningitis complicated by ventriculitis.
Conclusion: A change in epidemiology of acute bacterial meningitis compared to previous studies in Oman. High C reactive protein with high CSF white cell count and protein found to be significantly suggestive of bacterial than viral meningitis. Proper follow up plan for complicated meningitis cases to be established preventing long term sequales.