Clinical Characteristics and Molecular Epidemiology of Children Meningitis in Tehran, Iran; A Prospective Study

AbstractIntroductionMolecular epidemiology of children meningitis is very scarce and unclear in Iran. We aimed to characterize its clinical as well as paraclinical features and to determine the distribution of genotype/capsular types of common children bacterial meningitis agents in Iran. Material and methodAll meningitis suspected children aged four days to 15 years were enrolled in a prospective cross-sectional study from January 2015 to September 2017. Diagnostic values of clinical features, CSF, and serum parameters were evaluated independently and in combination with each other by multivariate logistic regression to develop a diagnostic rule. Genotype/capsular types of the all isolates were determined by targeting serotype-specific genes with uniplex or multiplex PCR. ResultAmong 119 meningitis suspected patients, 43 were bacterial meningitis, 19 with aseptic meningitis, 56 Non-meningitis cases (NMC), and one with tuberculous meningitis. Presentation of four features at the same time (CSF WBC & Pro & Poly & Serum-CRP) revealed 100 % sensitivity and 86.4 % specificity for diagnosis of bacterial meningitis. H. influenza type b (Hib) (60%), S. pneumoniae serotype 3 (28.5%), and N. meningitidis B (NmB) (63.5%) were the most prevalent serotypes. ConclusionThis study demonstrated that well-designed combination of clinical and paraclinical features could be useful but not good enough to be relied upon as stand-alone, rule-out tests for diagnosis of bacterial meningitis. Moreover, public immunization of infants with the most prevalent bacterial meningitis serotypes is recommended.