Meningococcal Meningitis: A Multicentric Hospital-based Study in Kathmandu, Nepal
Supriya Sharma1, *, Jyoti Acharya2, Dominique A. Caugant3, Jeewan Thapa4, Manju Bajracharya5, Madhusudan Kayastha6, Saroj Sharma6, Bimal S. Chalise7, Ragesh Karn8, Megha R. Banjara1, Prakash Ghimire1, Anjana Singh1
1 Central Department of Microbiology (CDM), Tribhuvan University (TU), Kirtipur, Kathmandu, Nepal
2 Department of Bacteriology Laboratory, National Public Health Laboratory (NPHL), Teku, Kathmandu, Nepal
3 WHO Collaborating Centre for Reference and Research on Meningococci, Norwegian Institute of Public Health, Oslo, Norway
4 Department of Medicine, Bir Hospital, Mahaboudha, Kathmandu, Nepal
5 Department of Emergency, Bhaktapur Hospital, Dudhpati, Bhaktapur, Nepal
6 Department of Emergency, Kanti Children's Hospital (KCH), Maharajgunj, Kathmandu, Nepal
7 Department of Medicine, Sukraraj Tropical and Infectious Diseases Hospital (STIDH), Teku, Kathmandu, Nepal
8 Department of Neurology, Tribhuvan University Teaching Hospital (TUTH), Maharajgunj, Kathmandu, Nepal
The global epidemiology of meningococcal disease varies markedly by region and over time. In Nepal, information on serogroup of meningococci is not available since the 1983 serogroup A epidemic in Kathmandu.
To provide some fundamental data on the circulating serogroups of meningococci for potential meningococcal immunization programs in Nepal.
This cross-sectional prospective study was conducted from January 2017 to December 2018 among 387 clinically suspected meningitis cases. Cerebrospinal fluid samples were collected by lumbar puncture technique at five referral hospitals of Kathmandu and processed by conventional cultural techniques. Neisseria meningitidis was identified by colony morphology, Gram staining and oxidase test. Serogrouping of meningococci was performed by slide agglutination test. Antibiotic susceptibility testing was done by the modified Kirby Bauer disc diffusion method. The data was entered into IBM SPSS Statistics 21 software and a p-value of <0.05 was considered significant.
Thirty-two samples were positive by culture for a bacterial pathogen with 2.3% of meningococci. All except one meningococcal meningitis cases were aged below 15 years. All N.meningitidis isolates belonged to serogroup A and were susceptible to ceftriaxone, chloramphenicol, meropenem and minocycline; however, 22% isolates showed resistance to cotrimoxazole and 11% intermediate resistance to ciprofloxacin.
The circulating serogroup of N. meningitidis in Kathmandu has not changed over the past 35 years. The prevalence of meningococcal meningitis in Kathmandu is low but might be underestimated due to the sole use of culture-based diagnostic methods. Detection of meningococci by alternative methods may be useful in the precise estimation of actual disease burden.
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* Address correspondence to this author at Central Department of Microbiology (CDM), Tribhuvan University (TU), Kirtipur, Kathmandu, Nepal;