J Korean Med Sci.  2010 Jun;25(6):895-899. 10.3346/jkms.2010.25.6.895.

The Causative Organisms of Bacterial Meningitis in Korean Children in 1996-2005

• Cho HK
• Lee H
• Kang JH
• Kim KN
• Kim DS
• Kim YK
• Kim JS
• Kim JH
• Kim CH
• Kim HM
• Park SE
• Oh SH
• Chung EH
• Cha SH
• Choi YY
• Hur JK
• Hong YJ
• Lee HJ
• Kim KH

• KMID: 2150869
• DOI: http://doi.org/10.3346/jkms.2010.25.6.895

Abstract

Bacterial meningitis remains a serious cause of morbidity and mortality in childhood, despite the availability of effective vaccines against Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae. The purpose of this study was to analyze data on bacterial meningitis cases in Korea from 1996 through 2005. The information of all hospitalized bacteria-proven meningitis cases was obtained from 17 university hospitals nationwide. A total of 402 cases were identified. Of these, 125 (29.9%) cases were neonates. Streptococcus agalactiae was the most common bacteria responsible for 99 (24.6%) of all cases regardless of age, followed by S. pneumoniae for 91 (22.6%) and H. influenzae for 67 (16.7%) patients. The common etiology beyond the neonatal period was S. pneumoniae for 91 (33.0%) followed by H. influenzae for 63 (22.8%) patients. The overall case fatality rate was 9.4%, which was similar with that in 1986-1995. In conclusion, S. agalactiae, S. pneumoniae and H. influenzae were important etiologic agents of bacterial meningitis in children in the last 10 yrs. It is required to establish the preventive strategy of the three bacteria. The nationwide epidemiologic study should be continued to evaluate immunization strategy and efficacy.

Keyword

Meningitis, Bacterial; Etiology; Epidemiology; Streptococcus pneumoniae; Haemophilus influenzae; Streptococcus agalactiae; Neisseria meningitidis

Figure

• 

  Fig. 1 Yearly distribution of bacterial meningitis according to etiologic agents. The incidence of H. influenzae meningitis has markedly decreased since 2001. *The category "others" included coagulase negative Staphylococcus (26 cases, 6.5%), Streptococcus (other than S. agalactiae) (15 cases, 3.7%), Staphylococcus aureus (15 cases, 3.7%), Klebsiella pneumoniae (11 cases, 2.7%), Enterococcus species (10 cases, 2.5%), Enterobacter cloacae (5 cases, 1.2%), Salmonella species (4 cases, 1.0%), Acinetobacter species (4 cases, 1.0%), Listeria species (3 cases, 0.7%), Pseudomonas aeruginosa (3 cases, 0.7%), Mycobacterium tuberculosis, Proteus mirabilis, Flavobacterium indologans and Gramnegative bacilli.

Reference

1. Centers for Disease Control and Prevention (CDC). Trends in perinatal group B streptococcal disease-United States, 2000-2006. MMWR Morb Mortal Wkly Rep. 2009. 58:109–112.

2. Fluegge K, Siedler A, Heinrich B, Schulte-Moenting J, Moennig MJ, Bartels DB, Dammann O, von Kries R, Berner R. German Pediatric Surveillance Unit Study Group. Incidence and clinical presentation of invasive neonatal group B streptococcal infections in Germany. Pediatrics. 2006. 117:e1139–e1145.

3. Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003. 361:2139–2148.

4. Chávez-Bueno S, McCracken GH Jr. Bacterial meningitis in children. Pediatr Clin North Am. 2005. 52:795–810.

5. Kim KH, Sohn YM, Kang JH, Kim KN, Kim DS, Kim JH, Kim CH, Shin YK, Oh SH, Lee HJ, Cha SH, Hong YJ, Sohn KC. The causative organisms of bacterial meningitis in Korean children, 1986-1995. J Korean Med Sci. 1998. 13:60–64.

6. Kim KH, Lee H, Chung EH, Kang JH, Kim JH, Kim JS, Lee HJ, Oh SH, Park EA, Park SE. Immunogenicity and safety of two different Haemophilus influenzae type b conjugate vaccines in Korean infants. J Korean Med Sci. 2008. 23:929–936.

7. Cowgill KD, Ndiritu M, Nyiro J, Slack MP, Chiphatsi S, Ismail A, Kamau T, Mwangi I, English M, Newton CR, Feikin DR, Scott JA. Effectiveness of Haemophilus influenzae type b Conjugate vaccine introduction into routine childhood immunization in Kenya. JAMA. 2006. 296:671–678.

8. Adegbola RA, Secka O, Lahai G, Lloyd-Evans N, Njie A, Usen S, Oluwalana C, Obaro S, Weber M, Corrah T, Mulholland K, McAdam K, Greenwood B, Milligan PJ. Elimination of Haemophilus influenzae type b (Hib) disease from The Gambia after the introduction of routine immunisation with a Hib conjugate vaccine: a prospective study. Lancet. 2005. 366:144–150.

9. Lee YJ, Lee SJ, Park HJ, Lee YH, Kang SY, Kim YC, Lee IK, Lee KY, Lee KS, Kim WS. A clinical study of child bacterial meningitis in Daejeon and Chungcheong area: 2001-2005. Korean J Pediatr. 2007. 50:157–162.

10. Kim HJ, Lee JW, Lee KY, Lee HS, Hong JH, Hahn SH, Whang KT. Causative organisms in children with bacterial meningitis (1992-2002). J Korean Pediatr Soc. 2003. 46:1085–1088.

11. Sáez-Llorens X, McCracken GH Jr. Antimicrobial and anti-inflammatory treatment of bacterial meningitis. Infect Dis Clin North Am. 1999. 13:619–636.

12. Schuchat A, Robinson K, Wenger JD, Harrison LH, Farley M, Reingold AL, Lefkowitz L, Perkins BA. Bacterial meningitis in the United States in 1995. Active Surveillance Team. N Engl J Med. 1997. 337:970–976.

13. Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S, Craig AS, Schaffner W, Zansky SM, Gershman K, Stefonek KR, Albanese BA, Zell ER, Schuchat A, Schrag SJ. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008. 299:2056–2065.

14. López Sastre JB, Fernández Colomer B, Coto Cotallo GD, Ramos Aparicio A. Grupo de Hospitales Castrillo. Trends in the epidemiology of neonatal sepsis of vertical transmission in the era of group B streptococcal prevention. Acta Paediatr. 2005. 94:451–457.

15. Mendsaikhan J, Watt JP, Mansoor O, Suvdmaa N, Edmond K, Litt DJ, Nymadawa P, Baoping Y, Altantsetseg D, Slack M. Childhood bacterial meningitis in Ulaanbaatar, Mongolia, 2002-2004. Clin Infect Dis. 2009. 48:Suppl 2. S141–S146.

16. Kalies H, Siedler A, Gröndahl B, Grote V, Milde-Busch A, von Kries R. Invasive Haemophilus influenzae infections in Germany: impact of non-type b serotypes in the post-vaccine era. BMC Infect Dis. 2009. 9:45.

17. Lewis RF, Kisakye A, Gessner BD, Duku C, Odipio JB, Iriso R, Nansera D, Braka F, Makumbi I, Kekitiinwa A. Action for child survival: elimination of Haemophilus influenzae type b meningitis in Uganda. Bull World Health Organ. 2008. 86:292–301.

18. Kelly DF, Moxon ER, Pollard AJ. Haemophilus influenzae type b conjugate vaccines. Immunology. 2004. 113:163–174.

19. World Health Organization. WHO position paper on Haemophilus influenzae type b conjugate vaccines. Wkly Epidemiol Rec. 2006. 81:445–452.

20. Nigrovic LE, Kuppermann N, Malley R. Bacterial Meningitis Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era. Acad Emerg Med. 2008. 15:522–528.

21. Neuman HB, Wald ER. Bacterial meningitis in childhood at the Children's Hospital of Pittsburgh: 1988-1998. Clin Pediatr (Phila). 2001. 40:595–600.

22. Centers for Disease Control and Prevention (CDC). Pediatric bacterial meningitis surveillance-African region, 2002-2008. MMWR Morb Mortal Wkly Rep. 2009. 58:493–497.

23. Giorgi Rossi P, Mantovani J, Ferroni E, Forcina A, Stanghellini E, Curtale F, Borgia P. Incidence of bacterial meningitis (2001-2005) in Lazio, Italy: the results of a integrated surveillance system. BMC Infect Dis. 2009. 9:13.

24. Theodoridou MN, Vasilopoulou VA, Atsali EE, Pangalis AM, Mostrou GJ, Syriopoulou VP, Hadjichristodoulou CS. Meningitis registry of hospitalized cases in children: epidemiological patterns of acute bacterial meningitis throughout a 32-year period. BMC Infect Dis. 2007. 7:101.

25. Campagne G, Schuchat A, Djibo S, Ousséini A, Cissé L, Chippaux JP. Epidemiology of bacterial meningitis in Niamey, Niger, 1981-96. Bull World Health Org. 1999. 77:499–508.

26. Hsu HE, Shutt KA, Moore MR, Beall BW, Bennett NM, Craig AS, Farley MM, Jorgensen JH, Lexau CA, Petit S, Reingold A, Schaffner W, Thomas A, Whitney CG, Harrison LH. Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med. 2009. 360:244–256.

27. Choi EH, Kim SH, Eun BW, Kim SJ, Kim NH, Lee J, Lee HJ. Streptococcus pneumoniae serotype 19A in children, South Korea. Emerg Infect Dis. 2008. 14:275–281.

28. Husain EH, Al-Shawaf F, Bahbahani E, El-Nabi MH, Al-Fotooh KA, Shafiq MH, Al-Ateeqi N, Abo Talib MA. Epidemiology of childhood meningitis in Kuwait. Med Sci Monit. 2007. 13:CR220–CR223.

29. Baraff LJ, Lee SI, Schriger DL. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J. 1993. 12:389–394.

30. Grandgirard D, Leib SL. Strategies to prevent neuronal damage in paediatric bacterial meningitis. Curr Opin Pediatr. 2006. 18:112–118.