Molecular detection and serotyping of acute bacterial meningitis pathogens in Indian children

Abstract

Background: Acute bacterial meningitis (ABM) is a medical emergency that requires early diagnosis and prompt treatment. Understanding bacterial etiology and resistance patterns is critical for optimal management and reduction of mortality. Nucleic acid amplification tests, with high sensitivity and rapid results, are valuable for diagnosing ABM. This study aimed to identify the etiological agents of acute bacterial meningitis in children aged 1-59 months in India.

Materials and methods: 2004 CSF were collected from Children aged 1-59 months admitted to the ward/ ICU of seven study sites with probable meningitis between 2019 and 2023. The samples were subjected to conventional culture, 16s rRNA PCR, real-time Multiplex PCR for detecting S.pneumoniae, H.influenzae type b, N.meningitidis, and Quadraplex real-time Multiplex PCR to determine S.pneumoniae serotypes.

Results: A total of 2,004 cerebrospinal fluid (CSF) samples were analysed for ABM in children over a 51-month period. The majority of cases (61%) involved children aged 0-12 months, with males comprising 63% of the study population. Laboratory confirmation identified ABM pathogens in 13.6% of cases, predominantly S.pneumoniae (10.2%), followed by H.influenzae (2.3%) and N.meningitidis (1%). Serotyping revealed 20 pneumococcal serotypes, with 19 F, 6 A, and 6B being the most prevalent, and 32.5% resistance to ceftriaxone was observed among pneumococcal isolates.

Conclusion: This study underscores the diagnostic value of molecular techniques in accurately determining the burden of ABM in young children, with Streptococcus pneumoniae identified as the predominant pathogen. These findings underscore the need for molecular methods, enhanced vaccination coverage, and continued surveillance to monitor pathogen prevalence, serotype distribution, and antimicrobial resistance patterns.

Keywords: Acute bacterial meningitis; Children; India; Molecular methods.