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Etiologies of Bacterial Meningitis in Bangladesh: Results from a Hospital-Based Study

We conducted a study at four hospitals from June 2003 to July 2005 to investigate the etiologies of bacterial meningitis in Bangladesh. A total of 2,609 patients met the clinical case definition, and 766 had cerebrospinal fluid tested by at least one of the following methods: latex agglutination, 16S rRNA gene sequencing, or real-time polymerase chain reaction for Neisseria meningitidis A and C, Streptococcus pneumoniae, and Haemophilus influenzae type b (Hib); culture results were noted from patient records. In total, 189 patients (24%) of those tested, representing all age groups, were diagnosed with bacterial meningitis; 136 (18%) had meningococcal, 23 (3%) had pneumococcal, and 25 (3%) had Hib infection. Twenty percent of patients with Hib meningitis (5/25) were > 15 years old. Case-fatality ratios were 10% for N. meningitidis, 22% for S. pneumoniae, and 24% for Hib. Bacterial meningitis from vaccine-preventable pathogens causes significant morbidity and mortality in Bangladesh in adults and children.

Received March 19, 2009. Accepted for publication May 4, 2009.

Acknowledgments: ICDDR,B acknowledges the commitment of the CDC to its research efforts. The authors also acknowledge the hard work and dedication of Drs. Sultana Monira Hossain, Rahima Afroza, Abu Taher Azad, Farah Naz Shoma, Nahida Zafrin Tuly, Mohammed Monirul Islam Khan, Tarana Tanjima Azad Lucky, Enamul Haque, Mahidul Alam, Syed Mortaza Ali, and Bidith Ranjan in patient recruitment, enrollment, and data collection. The authors thank the CDC laboratories for their efforts in specimen testing, Nihar Roy for laboratory support, and Milton Quiah for administrative support.

Financial support: This study was funded by the Centers for Disease Control and Prevention.

^* Address correspondence to Emily S. Gurley, ICDDR,B, GPO 128, Dhaka 1000, Bangladesh. E-mail: egurley{at}icddrb.org

Note: Supplementary Appendix A appears online at www.ajtmh.org.

Authors’ addresses: Emily S. Gurley, Jahangir Hossain, and Stephen P. Luby, ICDDR,B, GPO 128, Dhaka 1000, Bangladesh. Susan P. Montgomery, Parasitic Diseases Branch, DPD/NCZVED/CDC, 4770 Buford Highway, MS F-22, Atlanta, GA 30341-3728. Lyle R. Petersen, Division of Vector Borne Infectious Diseases, Centers for Disease Control and Prevention, PO Box 2087, Fort Collins, CO 80522. James J. Sejvar, Division of Viral and Rickettsial Diseases, Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-39, Atlanta GA 30333. Leonard W. Mayer, Chief, Meningitis Laboratory, Meningitis and Vaccine Preventable Diseases Branch, CDC, 1600 Clifton Road NE, MS D-11, Atlanta, GA 30333. Anne Whitney, Centers for Disease Control and Prevention, MS D-11, 1600 Clifton Road NE, Atlanta, GA 30333. Peter Dull, Head Development Meningococcal Vaccines, Novartis Vaccines and Diagnostics, 350 Massachusetts Ave., 75SS/170J, Cambridge, MA 02139. Nazmun Nahar, Director, Clinical Services, BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders), Dhaka 1000, Bangladesh. A. K. M. Rafique Uddin, Specialist Doctors Centre, House # 35, Road # 2, Dhanmondi, Dhaka-1205, Bangladesh. M. Ekhlasur Rahman, Head, Department of Paediatrics, Dhaka Medical College Hospital, Dhaka 1000, Bangladesh. A. R. M. Saifuddin Ekram, Head, Department of Medicine, Rajshahi Medical College Hospital, Rajshahi 6000, Bangladesh. Robert F. Breiman, CDC-KEMRI, Nairobi, Kenya.