Adolfo Lutz Institute, Santo André Regional Center, Avenida Ramiro Colleoni, 240 - Vila Dora, Santo André, SP, 09040-160, Brazil.
City Hall of Santo André, Santo André Health Secretary, Rua Primeiro de Maio, 133 - Centro, Santo André, SP, 09015-030, Brazil.
Braz J Microbiol. 2024 Jun;55(2):1339-1348. doi: 10.1007/s42770-024-01292-3. Epub 2024 Mar 5.
Bacterial meningitis is still a significant public health concern, with high morbidity and mortality rates. Despite this, it is still a rare event that requires the bacterial invasion of the meninges. However, some predisposing factors can trigger recurrent episodes of meningitis. This study is aimed at determining the clinical characteristics and the molecular epidemiology of episodes of recurrent community-acquired meningitis with and without predisposing factors. For this purpose, we performed a retrospective study of our laboratory database during the period of 2010 to 2020. Additionally, using molecular tools developed in our previous works, the epidemiology of the pathogens causing these episodes was analyzed using cerebrospinal fluid samples, especially in the absence of isolated strains. We observed a total of 1,779 meningitis cases and 230 were caused by Streptococcus pneumoniae. Of those, 16 were recurrent meningitis episodes (16/1,779; 0.9%) from seven patients. Pneumococcus was the main agent responsible in these recurrent episodes and only two episodes were caused by Haemophilus influenzae. The mean age of these patients was 20 years old and three had predisposing factors which could have led to contracting meningitis. The samples presented different pneumococcal serotypes. Most of them were non-vaccine-covered serotypes and antibiotic susceptible strains. Therefore, it was demonstrated how the practical employment of molecular tools, developed for research, when applied in the routine of diagnosis, can provide important information for epidemiological surveillance. Furthermore, it was shown how pneumococcus was the leading cause of recurrent community-acquired meningitis without predisposing factors, suggesting that pneumococcal vaccination may be necessary, even in those groups of individuals considered to be less susceptible.
细菌性脑膜炎仍然是一个重大的公共卫生问题，具有很高的发病率和死亡率。尽管如此，它仍然是一种罕见的事件，需要细菌侵犯脑膜。然而，一些诱发因素可能会引发复发性脑膜炎发作。本研究旨在确定有和没有诱发因素的复发性社区获得性脑膜炎的临床特征和分子流行病学。为此，我们对 2010 年至 2020 年期间我们实验室数据库进行了回顾性研究。此外，我们使用以前工作中开发的分子工具，使用脑脊液样本分析引起这些发作的病原体的流行病学，特别是在没有分离株的情况下。我们观察到总共 1779 例脑膜炎病例，其中 230 例由肺炎链球菌引起。在这些病例中，有 16 例是来自 7 名患者的复发性脑膜炎发作（16/1779；0.9%）。肺炎链球菌是这些复发性发作的主要病原体，只有 2 例由流感嗜血杆菌引起。这些患者的平均年龄为 20 岁，有 3 人有诱发因素，可能导致脑膜炎。样本中存在不同的肺炎球菌血清型。它们大多数是非疫苗覆盖的血清型和抗生素敏感株。因此，展示了如何在诊断常规中实际应用为研究开发的分子工具可以为流行病学监测提供重要信息。此外，还表明肺炎球菌是无诱发因素的复发性社区获得性脑膜炎的主要原因，这表明即使在那些被认为不易感染的人群中，也可能需要进行肺炎球菌疫苗接种。
