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Introduction: Bacterial Meningitis (BM) is a serious health problem worldwide with high mortality and permanent longterm neurological sequelae. Cerebrospinal Fluid (CSF) analysis is the cornerstone for diagnosing BM, but the lack of specificity creates a difficult clinical scenario for initiating proper treatment. Empiric antibiotic use in patients with suspected meningitis at primary care settings decreases the yield of CSF culture and alters CSF cytological and biochemical findings, making it further difficult to diagnose BM. To overcome this difficulty, there is a need for other biochemical markers with higher sensitivity and specificity. Aim: To determine the diagnostic sensitivity and specificity of Procalcitonin (PCT) in serum and CSF in patients with BM and compare its diagnostic accuracy in both sample types. Materials and Methods: A cross-sectional study was conducted in the Department of Internal Medicine at a tertiary care centre in eastern India from September 2018 to August 2020. A total of 82 adult patients with meningitis were recruited as per the protocol, and CSF analysis was done along with estimation of PCT in serum and CSF. Receiver Operating Characteristics (ROC) curve analysis of serum and CSF PCT was used to determine sensitivity and specificity with a 95% confidence interval. Results: Out of the 82 patients recruited, 30 (36.6%) had BM. CSF PCT with a cut-off value of >0.45 ng/mL had a sensitivity of 86.7% and specificity of 92.3%. The sensitivity of serum PCT with a cut-off value of >0.6 ng/mL was 83.3%, and specificity was 86.5%. There was no statistically significant difference in sensitivity and specificity between CSF and serum PCT in patients with BM (p-value=0.7988). Conclusion: Both serum and CSF PCT were found to have high sensitivity and specificity as markers for diagnosing BM without any statistically significant difference between them. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal bacterial meningitis (NBM) is the most devastating complication of late‑onset sepsis with incidence ranging from 12.5% to 61.11% with a mortality rate of 16‑45.5% and disability rate of 25-50%. Objectives: To estimate the clinical and laboratory predictors of mortality in outborn neonates with NBM. Methods: A prospective observational study was carried out on 150 outborn neonates with late‑onset sepsis and with clinically diagnosed meningitis; and CSF biochemical abnormalities with or without CSF culture positivity at a tertiary care teaching hospital in central India over a period of 2 years. Data on demographic, maternal, neonatal, and socio‑cultural factors were recorded and analyzed using a univariate and multiple regression model. Results: Distance travelled more than 150 km (OR 1.01, CI 1.0‑1.02, P = 0.04), transport duration >3 hrs (OR 4.58, CI 2.07‑10.11, P < 0.0001), premature rupture of membrane >24 hours (OR 9.68, CI 2.14‑43.70, P < 0.0001), transaminitis (SGPT >40IU/L) (OR 0.93, CI 0.88‑0.97, P < 0.003), CSF turbidity (OR 16.70, CI 4.45‑62.70, P < 0.0001), raised CSF protein (OR 8.81, CI 1.45‑53.34, P = 0.018), and low CSF sugar (OR 20.48, CI 4.18‑100.26, P < 0.0001) were independent predictors of mortality in neonatal meningitis on multivariate analysis. Conclusion: Anticipation, early recognition, and prompt treatment of maternal, neonatal, socio‑cultural, and laboratory risk factors are important to reduce the mortality of devastating complication of late‑onset sepsis. [ABSTRACT FROM AUTHOR]

Background and Objectives: Bacterial meningitis (BM) poses a considerable global public health concern. C-reactive protein (CRP) has emerged as a viable diagnostic marker, particularly in differentiating bacterial and aseptic meningitis, especially in cases where bacterial culture results are negative in both blood and cerebrospinal fluid (CSF) samples. The present study was done with the primary objective of estimating the serum CRP levels in pediatric meningitis cases caused by bacterial pathogens. Materials and Methods: A hospital-based descriptive cross-sectional study was undertaken at a renowned tertiary care hospital in India, involving the evaluation of 222 samples. Cerebrospinal fluid samples were collected following standard guidelines, and bacterial identification and antimicrobial susceptibility testing were carried out using an automated system. Quantitative estimation of CRP levels was performed using a solid-phase, sandwich-format immunometric assay employing a gold antibody conjugate. Results: The study cohort consisted of pediatric meningitis cases with a median age of 3.9 years, ranging from 1 to 4.6 years. Among the bacterial isolates, Escherichia coli was identified as the most prevalent pathogen, followed by Klebsiella pneumoniae. Notably, 31.32% of the participants exhibited elevated serum CRP levels. Moreover, a statistically significant association was observed between elevated serum CRP levels and cases with Gram-negative bacterial etiology. Conclusion: Elevated serum CRP can serve as a valuable diagnostic marker for identifying pediatric bacterial meningitis cases with a Gram-negative etiology. The utilization of CRP as a diagnostic adjunct can aid in timely and accurate differentiation between bacterial and aseptic meningitis, facilitating appropriate clinical management and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Bacterial meningitis is the most common cause of post-natal acquired hearing loss in children. Although cochlear implantation helps in improving the hearing in these patients, the fibrosis and ossification of the cochlear lumen that occurs as a result of bacterial meningitis, limits the chances of successful implantation. In developing countries like India, the reduced awareness, limited resources, and financial constraints warrant judicial use of radiological and audiological tests to increase the rate of successful cochlear implantation. The present paper is a review of the literature and a proposed protocol for follow-up of post-meningitis patients to help clinicians diagnose and hence, intervene early when profound hearing loss occurs. Every patient who has had an episode of bacterial meningitis must be followed up for atleast 2 years for possible hearing loss with frequent audiological and radiological evaluation, as required. Cochlear implantation must be done as early as possible when profound hearing loss is detected. [ABSTRACT FROM AUTHOR]

Introduction: Acinetobacter is a non fermenting, Gram negative bacillus, a causative pathogen of hospital-acquired infections due to its inherent Multidrug-Resistant (MDR) property. It is held responsible for the majority of nosocomial meningitis in patients undergoing neurosurgical procedures. Aim: To identify the clinical characteristics, drug-resistance and mortality rate among the patients suffering from meningitis caused by Acinetobacter baumannii. Materials and Methods: This retrospective, single-centre study was carried out in the Bacteriology section of the Department of Microbiology at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, from February 2019 to February 2022. A total of 150 Cerebrospinal Fluid (CSF) samples from routine bacterial culture-confirmed patients were included in the study. All clinical data were extracted from the Hospital Information System (HIS). All the isolates were identified by Matrix Assisted Laser Desorption/Ionisation-Time of Flight-Mass Spectrometry (MALDI-TOF-MS) assay and antibiotic sensitivity testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: The study included 150 (7.55%) cases of culture-proven bacterial meningitis among 1986 CSF samples collected from February 2019 to February 2022. There were 45 (30.0%) cases of Acinetobacter meningitis. Thirty-five (77.8%) patients had undergone neurosurgical procedures for the removal of spaceoccupying lesions from the brain parenchyma. Forty-two (93.3%) isolates were resistant to amikacin and a cumulative resistance of almost 93.3-95.6% was observed among cephalosporins. Fluoroquinolone resistance was observed in 43 (95.6%) patients and carbapenem resistance was observed in 42 (93.33%) isolates. Overall, 12 (26.7%) succumbed to their infections. Conclusion: Acinetobacter meningitis causes delay in the recovery of the patient undergoing intracranial surgery, amounting to a delay in brain parenchyma healing in the case of neurosurgical patients. [ABSTRACT FROM AUTHOR]

Background: Cerebrospinal infections are the cause of poor prognosis among post-neurosurgery patients owing to delay in improvement of neurological functions, leading to increased length of hospital stay, proceeding to disability or death. Methods and materials: This retrospective observational study was performed at a tertiary care center in Northern India, where all patients with bacterial cerebrospinal infections from July 2019 to July 2022 were evaluated for post-neurosurgery cerebrospinal shunt infections, and all demographic data and risk factors were extracted from the hospital information system (HIS). Results: The study includes 150 (150/1986, 7.55%) culture-confirmed cases of bacterial meningitis out of 1986 cases of suspected bacterial meningitis patients. Ninety-six (96/150, 64.0%) post-neurosurgery patients with cerebrospinal fluid (CSF) leaks were managed using external ventricular drain (EVD) or ventriculo-peritoneal (VP) shunt. Seventy-four (74/96, 77.08%) patients were managed only on EVD, whereas 22 (22/96, 22.92%) patients were managed only on VP shunt. Eighty-two (82/96, 85.4%) multidrug-resistant microorganisms (MDROs)were isolated and 70 (70/82, 85.36%) were Gram-negative bacteria, of which 56 (56/74, 75.68%) Gram-negative bacteria showed extended-spectrum betalactamase (ESBL)-producing character in those with an EVD, 14 (14/22, 63.63%) with a VP shunt. Among Gram-negative bacteria, Acinetobacter baumannii showed high rates of resistance: 21 (21/23, 91.30%) and 8 (8/8, 100%) were ESBL-producing A. baumannii in patients managed on EVD and VP shunt, respectively. Conclusion: This study determines the risk factors, the spectrum of pathogenic microorganisms, multidrug resistance, and the nature of intracranial lesions isolated among the patients who developed bacterial cerebrospinal infections in post-neurosurgery patients. [ABSTRACT FROM AUTHOR]

Introduction: Bacterial meningitis especially in neonates remains a major cause of mortality and long term health sequelae. There is a need for periodic review, since pathogens responsible for the meningitis vary with time and geography. Aim: To find the culture positivity of Cerebrospinal Fluid (CSF) specimens before and after installation of automated blood culture and identification system in suspected neonatal meningitis cases. Materials and Methods: The present descriptive cross-sectional study was carried out during July 2020 to December 2020, for six months duration in Department of Microbiology, Rural medical college, (Pravara Institute of Medical Sciences-Deemed University), Loni, Maharashtra, India. All CSF specimens from neonates <28 days received in Department of Microbiology were included in the study. All CSF specimens collected in BacT/Alert bottle were incubated and further subjected to identification by Vitek 2 system. All CSF specimen smears, received were subjected to Gram staining and Ziehl Neelsen Staining. Descriptive statistics was used for result analysis. Results: A total of 265 CSF specimens were received during the study period. Males (59%) outnumbered females (41%) in the present study. Bacterial growth by automated blood culture system (BacT/Alert 3D) was detected in 85 CSF specimen giving the culture positivity as 32.08%. The most common bacterial isolate was found to be Staphylococcus haemolyticus followed by Enterococcus species and Acinetobacter species. Also, an attempt was made to compare culture positivity results with results by conventional culture method before installation of automation which showed heightened results for culture positivity and diversity of clinical isolates. Conclusion: Bacterial neonatal meningitis is a common entity and aetiological diagnosis is crucial in every healthcare setting. The present study describes the various aetiological agents isolated by automated blood culture system in neonatal CSF specimens. Retrospective comparison with conventional culture has shown promising results for automated system. Early isolation and definitive identification with drug sensitivity, has got massive impact in management of neonate, further in timely progression of child's developmental milestones. [ABSTRACT FROM AUTHOR]

Objective: To perform systematic review and meta-analysis of meningococcal disease burden in India. Methods: We searched publications on meningococcal disease in India between 1996 and 2020 using PubMed and Google Scholar. Prevalence (proportion) of Meningococcal meningitis and Case-fatality ratio (CFR) were pooled using random effects model. Other outcomes were pooled qualitatively. Results: The prevalence of Meningococcal meningitis in epidemic and endemic conditions was 12.1% (95% CI: 5.2-21.4) and 0.76% (95% CI: 0.3-1.4), respectively, with a CFR of 12.8% (95% CI: 6.8-20.4) in epidemic settings; N. meningitis caused 3.2% (95% CI: 1.6-5.3) of Acute Bacterial Meningitis (ABM) cases in endemic settings. The disease appeared in infants, adolescents, and adults with Serogroup A prevalence. Treatment and prophylaxis were limited to antibiotics despite increased resistance. Conclusion: The study reveals epidemic and endemic presence of the disease in India with high fatality and serogroup A prevalence. Further monitoring and immunization are required to prevent outbreaks. [ABSTRACT FROM AUTHOR]

Introduction: Febrile Seizures (FS) are the most common type of childhood seizures, affecting 2-5% of children older than one month and most commonly from six months to 5-year-old. It is a major cause of paediatric admissions worldwide. In India, American Academy of Paediatrics (AAP) 2010 guidelines are followed for performing Lumbar Puncture (LP) in first episode of FS, despite the fact that epidemiological differences exist between the two countries. The present study has been done to find out whether AAP guidelines are applicable in India. Aim: To find out the prevalence and predictors of meningitis in first episode of FS in children aged 6-18 months. Materials and Methods: This was a cross-sectional study carried out in 200 children, aged between 6-18 months admitted with first episode of FS in Paediatric Ward of tertiary care hospital New Delhi, India, over a period of 18 months (May 2018 to December 2019). The LP was performed and blood, Cerebrospinal Fluid (CSF), clinical parameters were analysed using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: The prevalence of meningitis in children aged 6-18 months presenting with first episode of FS was 16% (n=32). Bacterial Meningitis (BM) was seen in 3% (n=6) of cases. The independent predictors of meningitis were high Total Leucocyte Count (TLC) (>16500 cells/mm3) and positive C-Reactive Protein (CRP). Blood culture was positive in seven cases (three cases of Streptococcus pneumoniae, two MRSA, one each Klebsiella pneumoniae and Neisseria meningitidis). Most common type of cell seen was monocytes which was alone seen in 56.2% (n=18) of the meningitis cases. Conclusion: India should have its own guidelines for performing LP in cases of first episode of FS as the prevalence of meningitis in children with first episode of FS in India is more than in the USA, and immunisation coverage for Haemophilus and Pneumococcal Vaccine (PCV) is very less as compared to USA. Meningitis can be predicted in those with high TLC (16500 cells/mm³) and CRP positive. [ABSTRACT FROM AUTHOR]

The aim of this article was to study the spectrum of scrub typhus meningitis/meningoencephalitis (STM) cases in children. Children ≤14 years of age with acute undifferentiated febrile illness were included. Immunoglobulin M (IgM) enzyme-linked immunosorbent assay was done in blood and cerebrospinal fluid (CSF) of children with suspected STM. Demographic, clinical, and laboratory details were expressed as descriptive statistics. Factors associated with neurological involvement were identified on univariate analysis. A total of 76 children had ST during the study period (meningitis/meningoencephalitis = 8 [10.5%], of which 5 [62.5%] had detectable ST IgM antibodies in CSF). The included children were 4 to 12 years of age with boys > girls. Headache and vomiting were common in those with STM, whereas hyponatremia and thrombocytopenia were common in those without STM. All children with STM recovered with sequelae in one child (right lateral rectus palsy). There was no mortality. STM has an incidence of 10.5% in children with ST from Eastern India. Headache and vomiting were significant predictors of STM, whereas hyponatremia and thrombocytopenia were significant predictor of non-STM. [ABSTRACT FROM AUTHOR]

Background In February 2020, a man returned to the United States after an 11-day trip to India and died of primary amebic meningoencephalitis (PAM), caused by nasal exposure to the free-living ameba Naegleria fowleri found in warm water. We identified potential exposures, confirmed etiology, and described the molecular epidemiology of the infection. Methods We reviewed medical records to describe his clinical course and interviewed his family to determine water exposures. Genotyping was performed on the N. fowleri strain and compared with North American strains through repetitive nonpolymorphic nuclear loci analysis to identify differences. We reviewed N. fowleri strains in the National Center for Biotechnology Information database (GenBank) to determine genotypes present in India. Results The patient became acutely encephalopathic 3 days after returning; the only known nasal water exposure was at an indoor swimming pool in India 5 days earlier. Cerebrospinal fluid (CSF) testing demonstrated neutrophil-predominant pleocytosis and low glucose, but negative gram stain and culture. CSF microscopy revealed trophozoites; N. fowleri was detected by real-time polymerase chain reaction. Classical genotyping confirmed genotype I, common in the United States and among Indian strains in GenBank. The North American N. fowleri strains and the patient's strain varied at 5 nonpolymorphic loci. Conclusions A man died from PAM after likely exposure at a vacation rental pool in India. We recommend including PAM in the differential diagnosis when CSF studies suggest bacterial meningitis but gram stain is negative. Genotyping can advance our understanding of N. fowleri molecular epidemiology and support future investigations. [ABSTRACT FROM AUTHOR]

Studies show nearly half to two-thirds of the children in India to be deficient in vitamin B12. Meningitis is a major disease in Indian children with studies attributing up to 22% of under-five deaths to meningitis and pneumonia. India is one of the countries with the highest mortality in absolute numbers due to meningitis. Usually, the diagnosis of each of these entities is straightforward. The presence of meningeal signs, papilledema, seizures, and altered sensorium often suggests meningitis. And vitamin B12 deficiency has a myriad of clinical presentations. At times, encephalopathy secondary to cobalamin deficiency may be confused with infection. Here, we present a case that presented with signs and symptoms suggestive of central nervous system infection but turned out to be cobalamin deficiency eventually. To our knowledge, this is the first presentation of cobalamin deficiency presented with features suggestive of meningitis. [ABSTRACT FROM AUTHOR]

• Generated data on bacterial meningitis burden among under-five children in India. • S. pneumoniae the commonest etiology with high proportion of MDR strains. • Two-thirds of pneumococcal serotypes covered by PCV13. • Continued surveillance needed to assess the impact of PCV following introduction. A hospital-based sentinel surveillance network for bacterial meningitis was established in India to estimate the burden of bacterial meningitis, and the proportion of major vaccine-preventable causative organisms. This report summarises the findings of the surveillance conducted between March 2012, and September 2016 in eleven hospitals. We enrolled eligible children with bacterial meningitis in the age group of one to 59 months. CSF samples were collected and processed for biochemistry, culture, latex agglutination, and real-time PCR. Pneumococcal isolates were serotyped and tested for antimicrobial susceptibility. Among 12 941 enrolled suspected meningitis cases, 586 (4.5%) were laboratory confirmed. S. pneumoniae (74.2%) was the most commonly detected pathogen, followed by H. influenzae (22.2%), and N. meningitidis (3.6%). Overall 58.1% of confirmed bacterial meningitis cases were children aged between one, and 11 months. H. influenzae meningitis cases had a high (12.3%) case fatality rate. The serotypes covered in PCV13 caused 72% pneumococcal infections, and the most common serotypes were 14 (18.3%), 6B (12.7%) and 19F (9.9%). Non-susceptibility to penicillin was 57%. Forty-five (43.7%) isolates exhibited multidrug resistance, of which 37 were PCV13 serotype isolates. The results are representative of the burden of bacterial meningitis among under-five children in India. The findings were useful in rolling out PCV in the National Immunization Program. The non-susceptibility to penicillin and multidrug resistance was an important observation. Timely expansion of PCV across India will significantly reduce the burden of antimicrobial resistance. Continued surveillance is needed to understand the trend after PCV expansion in India. [ABSTRACT FROM AUTHOR]

Penicillin-binding proteins are the primary targets for beta lactam drugs, which are main stay of treatment for Streptococcus pneumoniae. The emergence of increased penicillin resistance in meningeal isolates of S. pneumoniae in India is alarming. With this background, we aimed to analyze the pbp gene mutations of penicillin nonsusceptible pneumococcal (PNSP) isolates from within India and their association with international clones. A total of 32 PNSP invasive isolates with a penicillin minimal inhibitory concentrations (MIC) of ≥0.12 μg/mL were subjected to PCR and sequencing for multilocus sequence typing and the pbp genes (pbp2b, pbp2x, and pbp1a). The S. pneumoniae R6 susceptible strain was used as the reference for the comparison analyses. In the majority of the present study isolates, amino acid substitutions were only seen in one of the three active sites of one of the three pbp genes. Thus, pbp genes in the absence of the major substitutions usually associated with penicillin resistance combined with mosaicism in pbp1a resulted in a slight increase in the penicillin MIC to between 0.06 and 2.0 μg/mL, which according to meningeal break point denote resistance. Clonal analyses revealed that the emergence of PNSP in India is due to the gradual expansion of the resistant clones CC320, CC230, and CC63. [ABSTRACT FROM AUTHOR]

Objective: To perform systematic review and meta-analysis of meningococcal disease burden in India. Methods: We searched publications on meningococcal disease in India between 1996 and 2020 using PubMed and Google Scholar. Prevalence (proportion) of Meningococcal meningitis and Case-fatality ratio (CFR) were pooled using random effects model. Other outcomes were pooled qualitatively. Results: The prevalence of Meningococcal meningitis in epidemic and endemic conditions was 12.1% (95% CI: 5.2-21.4) and 0.76% (95% CI: 0.3-1.4), respectively, with a CFR of 12.8% (95% CI: 6.8-20.4) in epidemic settings; N. meningitis caused 3.2% (95% CI: 1.6-5.3) of Acute Bacterial Meningitis (ABM) cases in endemic settings. The disease appeared in infants, adolescents, and adults with Serogroup A prevalence. Treatment and prophylaxis were limited to antibiotics despite increased resistance. Conclusion: The study reveals epidemic and endemic presence of the disease in India with high fatality and serogroup A prevalence. Further monitoring and immunization are required to prevent outbreaks. [ABSTRACT FROM AUTHOR]

Background: Fever is a cause for concern for both parents and the treating pediatrician and a common reason for antibiotic overuse. However, the proportion of children hospitalized for fever with serious bacterial infection (SBI) is uncertain. We aimed to evaluate the epidemiological, clinical, hematological, and biochemical risks for SBI among the children admitted with fever.Method: This prospective study was conducted in a rural teaching hospital in India on consecutive children, aged 3 months-12 years, presenting with fever 100 °F (37.7 °C) or higher. The presence of SBI was confirmed with one of the following criteria: (a) a positive blood culture; (b) roentgenographically confirmed pneumonia with high titres of C-reactive protein; (c) a culture-confirmed urinary tract infection; (d) enteric fever diagnosed clinically in addition to either a positive blood culture or high Widal titers; and (e) meningitis diagnosed clinically in addition to either a positive blood culture or cerebrospinal fluid culture. A predefined questionnaire was filled.Results: A total of 302 children were included in the study, out of which 47% (95% CI 41.4-52.7%) presented with SBI. The factors associated with confirmed SBI in bivariate analysis were history of previous hospitalization, history of chronic illness, history of medication in the previous 1 week, a partially immunized child, history of common cold, moderate-grade fever, toxic look, significant lymphadenopathy, absence of BCG scar, delayed development, irritability, breathlessness, respiratory distress, poor feeding, significant weight loss, suspected urinary tract infection, hyponatremia, hypokalemia, and abnormal leucocyte count. The final generalized logistic regression model revealed partially immunized child (RR 4.26), breathlessness (RR 1.80), weight loss (RR 2.28), and suspected urinary tract infection (RR 1.95) as risk factors for the increased risk of SBI.Conclusion: The study identified multiple risk factors for SBI. Pediatricians can be made aware of these risk factors. Further studies are warranted to identify age-specific risk factors for SBI because most clinicians depend on clinical signs and symptoms to identify SBI. [ABSTRACT FROM AUTHOR]

Background: Worldwide, acute bacterial meningitis is a major cause of high morbidity and mortality among under five children, particularly in settings where vaccination for H. influenzae type b, S. pneumoniae and N. meningitidis is yet to be introduced in the national immunization programs. Estimation of disease burden of bacterial meningitis associated with these pathogens can guide the policy makers to consider inclusion of these newer vaccines in the immunization programs. A network of hospital based sentinel surveillance was established to generate baseline data on the burden of bacterial meningitis among children aged less than 5 years in India and to provide a platform for impact assessment following introduction of the Pentavalent and Pneumococcal Conjugate Vaccines (PCV). Methods: During surveillance carried out in select hospitals across India in 2012–2013, information regarding demographics, immunization history, clinical history, treatment details and laboratory investigations viz. CSF biochemistry, culture, latex agglutination and PCR was collected from children aged 1 to 59 months admitted with suspected bacterial meningitis. Results: A total of 3104 suspected meningitis cases were enrolled from 19,670 children admitted with fever at the surveillance hospitals. Of these, 257 cases were confirmed as cases of meningitis. They were due to S. pneumoniae (82.9%), H. influenzae type b (14.4%) and N. meningitidis (2.7%). Highest prevalence (55.3%) was observed among children 1 to 11 months. Antimicrobial susceptibility testing revealed considerable resistance among S. pneumoniae isolates against commonly used antibiotics such as cotrimoxazole, erythromycin, penicillin, and cefotaxime. More commonly prevalent serotypes of S. pneumoniae in circulation included 6B, 14, 6A and 19F. More than 90% of serotypes identified were covered by Pneumococcal Conjugate Vaccine 13. Conclusions: We observed that S. pneumoniae was the commonest cause of bacterial meningitis in hospitalized children under five years of age in India. Continued surveillance is expected to provide valuable information and trends in future, to take an informed decision on introduction of pneumococcal vaccination in Universal Immunization Programme in India and will also eventually help in post-vaccination impact evaluation. [ABSTRACT FROM AUTHOR]

• Acute encephalitis was a major health problem in Central India. • Children were affected more commonly than adults. • Infectious agents were associated with >40% of cases. • Viruses contributed to over three-fourths of acute encephalitis cases. • Japanese encephalitis virus continued to occur despite vaccination. We enhanced surveillance of hospitalizations of all ages for acute encephalitis syndrome (AES) along with infectious aetiologies, including the Japanese encephalitis virus (JEV). From October 2018 to September 2020, we screened neurological patients for AES in all age groups in Maharashtra and Telangana States. AES cases were enrolled at study hospitals along with other referrals and sampled with cerebrospinal fluid, acute and convalescent sera. We tested specimens for non-viral aetiologies viz. leptospirosis, typhoid, scrub typhus, malaria and acute bacterial meningitis, along with viruses - JEV, Dengue virus (DENV), Chikungunya virus (CHIKV), Chandipura virus (CHPV) and Herpes simplex virus (HSV). Among 4977 neurological hospitalizations at three study site hospitals over two years period, 857 (17.2%) were AES. However, only 287 (33.5%) AES cases were eligible. Among 278 (96.9%) enrolled AES cases, infectious aetiologies were identified in 115 (41.4%) cases, including non-viral in 17 (6.1%) cases - leptospirosis (8), scrub-typhus (3) and typhoid (6); and viral in 98 (35.3%) cases - JEV (58, 20.9%), HSV (22, 7.9%), DENV (15, 5.4%) and CHPV (3, 1.1%). JEV confirmation was significantly higher in enrolled cases than referred cases (10.2%) (p < 0.05). However, the contribution of JEV in AES cases was similar in both children and adults. JE was reported year-round and from adjacent non-endemic districts. The Japanese encephalitis virus continues to be the leading cause of acute encephalitis syndrome in central India despite vaccination among children. Surveillance needs to be strengthened along with advanced diagnostic testing for assessing the impact of vaccination. [ABSTRACT FROM AUTHOR]

Background: Meningitis remains a serious clinical problem in developing as well as developed countries. Delay in diagnosis and treatment results in significant morbidity and mortality. The role and levels of intrathecal endogenous cortisol is not known. Objective: To study the cerebrospinal fluid (CSF) cortisol levels and to evaluate its role as a diagnostic and therapeutic marker in acute bacterial meningitis. Materials and Methods: Thirty patients with acute bacterial meningitis with no prior treatment were evaluated. Cortisol levels were compared with 20 patients with aseptic (viral) meningitis and 25 control subjects. Results: Mean CSF cortisol level was 13.85, 3.47, and 1.05 in bacterial meningitis, aseptic meningitis, and controls, respectively. Mean CSF cortisol level in bacterial meningitis was significantly higher as compared to controls (P < 0.001). There was significant difference in CSF cortisol levels in bacterial and aseptic meningitis (P < 0.001). Conclusions: Cortisol levels in CSF are highly elevated in patients with acute bacterial meningitis. This suggests that intrathecalcortisol may serve as a valuable, rapid, relatively inexpensive diagnostic marker in discriminating between bacterial and aseptic meningitis. This helps in earlier institution of appropriate treatment and thereby decreasing morbidity and mortality. [ABSTRACT FROM AUTHOR]

B Background: b Bacterial pneumonia and other invasive bacterial diseases (IBDs) are leading causes of morbidity and mortality in under-five children globally. Towards understanding the trends in common etiologies of bacterial pneumonia/IBDs and serotype distribution of S. Pneumoniae in pre and post-vaccination scenario, a hospital based surveillance network was established in 2016. Common etiological agents include Streptococcus pneumoniae, Haemophilus influenzae type b (Hib) and Neisseria meningitidis. [Extracted from the article]

Objectives: To evaluate clinicolaboratory profile and the outcomes in children (1 to 59 months) diagnosed with Group B streptococcus (GBS) meningitis over a period of 1 year. Materials and Methods: Cerebrospinal fluid (CSF) samples of 250 pediatric patients (1 to 59 months) admitted with suspected acute bacterial meningitis(ABM)were subjected to cell count, biochemical profile, culture, latex particle agglutination (LPA) and polymerase chain reaction (PCR).They were also evaluated for complications and were followed-up till 6 months after discharge. Results: Forty patients (25 boys and 15 girls), 16% of total suspected cases of ABM were diagnosed with GBS by LPA method and 30 (75%) out of these were above 3 months of age. The median duration of hospital stay was 7 days (range 1 to 72 days). State of coma was observed in two (5%) and one (2.5%) died, while 20 (50%) patients recovered completely. Conclusion: GBS should be considered as an important cause of ABM in Indian children beyond the neonatal period and further studies are warranted to determine the actual problem of the disease in our country. [ABSTRACT FROM AUTHOR]

Background: Pentavalent vaccine (a combination vaccine which protects against five killer diseases- diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B) is being introduced in various states of India as a part of Universal Immunization Programme. In this context it is critical to establish sentinel sites across India for surveillance of H.influenzae type B meningitis and use this opportunity also for surveillance of pneumococcal and meningococcal meningitis. Keeping this in mind a hospital-based sentinel surveillance network was established at 11 places across the country and this study reports the results of first three years of this surveillance program. Methods & Materials: This study was conducted in six states of India through 11 hospital based sentinel sites. Children aged one to 59 monthswhometwith standard case definitions were included in the study and their sterile biological specimens were processed for laboratory identification of bacterial pathogens. Further characterizations of bacterial pathogens were in study reference laboratory. Reference laboratory reconfirmed bacterial identify and further characterized the isolates to identify serotypes and antimicrobial susceptibility profile. Results: A total of 10202 cases were suspected for bacterial meningitis in study population. Laboratory confirmed incidence rates for S. pneumonia, H. influenza and N. meningitidis in this study is found to be around 3.80%, 1.26% and 0.24% respectively. S. pneumoniae appears to be the predominant pathogen among laboratory identified bacterial pathogens with 71.7%, followed with H.influenzae (23.8%) and N.meningitidis (4.4%). For S.pneumoniae, 15% of positive cases had serotype data, showing serotypes 19F, 6B, 14, 6A and 14 were the predominant serotypes in India. Conclusion: Invasive bacterial disease appears to be a major problem in Indian children with S.pneumoniae dominating and H.influenzae decreasing in the pathogens list. If pneumococcal conjugate vaccine-13 incorporated into Universal Immunization Programme, it can provide protection against 79% of serotypes responsible for Invasive pneumococcal diseases in India. However continued surveillance representing all parts of the country is necessary to understand the complete picture of Invasive bacterial diseases in India. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article about the actual prevalence of group B streptococcus (GBS) meningitis in children in sub-Himalayan India by Chauhan et al.