RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF CANDIDATE
AND ADDRESS (IN BLOCK LETTERS) /

Dr. KAVYASHREE. C.V.

POSTGRADUATE STUDENT
DEPARTMENT OF MICROBIOLOGY
J.J.M.MEDICALCOLLEGE,
DAVANGERE – 577004.
2. / NAME OF THE INSTITUTION / J.J.M.MEDICALCOLLEGE,
DAVANGERE - 577004, KARNATAKA.
3. / COURSE OF STUDY & SUBJECT / M.D. MICROBIOLOGY
4. / DATE OF ADMISSION TO COURSE / 12.06.08
5. /

TITLE OF TOPIC

/ “BACTERIOLOGICAL STUDY OF ACUTE PYOGENIC MENINGITIS IN CHILDREN WITH SPECIAL REFERENCE TO LATEX AGGLUTINATION TEST”.
6. / BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the study:
Bacterial meningitis continues to be an important cause of morbidity and mortality in India and throughout the world despite the availability of effective antimicrobial therapy.1
There is a need for a periodic review of bacterial meningitis world wide, since the pathogens responsible for the infection vary with time, geography and patient’s age.2
The common organism’s implicated are Neisseria meningitidis, E.coli, Streptococcus pneumoniae, Haemophilus influenzae and Group B-Streptococci.3
C-reactive protein has been established as a marker of an acute phase response and in differentiating viral and bacterial meningitis.4
Etiological diagnosis can be enhanced by latex agglutination test (LAT) and with good culture media.5
Samples which did not show any evidence of the pathogen on either Gram’s stain or culture, were positive by latex agglutination test, thus helping to clinch the diagnosis.2
Latex agglutination test should be performed whenever the patient had received prior antibiotic treatment, and also whenever Gram stain fails to demonstrate any organism.7
The present study is carried out to know :
  1. The bacteriology of acute pyogenic meningitis.
  2. Antibiogram of these isolates.
  3. Usefulness of C-reactive protein (CRP) in the diagnosis of acute pyogenic meningitis and in comparison with Gram stain and culture.
  4. To know the sensitivity of latex agglutination test (LAT) compared to Gram stain and culture.

6.2 Review of Literature
In a study conducted by Viswanath G, Praveen, Hanumanthappa A.R, Chandrappa N.R, Baragundi Mahesh C, in department of microbiology, J.J.M. Medical College, in Davangere between July 2000 to July 2001. 150 children, clinically suspected of meningitis were studied. 40 (26.6%) cases were proven by laboratory investigations as pyogenic meningitis.Out of 40 cases,LAT were done in 20 cases. 12 (60%) cases were positive for both culture and LAT, 6 (30%) cases were positive for LAT, but negative by culture and 2 (10%) cases were negative by LAT but positive for culture.1
In a study conducted in NIMHANS Bangalore between Jan. 1996-Dec. 2005, 385 samples of CSF of patients with acute bacterial meningitis were examined. Gram stain were positive in 253 (65.9%) cases and culture were positive in 157 (40.8%) cases. Out of 67 culture negative cases, both Gram stain and LAT were positive in 55 cases and 12 cases were smear negative but only LAT positive.2
In a study conducted in Indore between 1993-1997, 1079 samples of CSF were analysed.The sensitivity of 6 mg/L of CRP for the latex agglutination test is adequate for diagnosis. CRP were positive in 169 cases out of227 cases of pyogenic meningitis,1 out of 143 cases of tuberculous meningitis and non in case of viral meningitis.4
In a study conducted in K.E.M.Hospital Pune for a period of 2 years (between 1999 – 2001) 54 children satisfied the criteria of acute bacterial meningitis. CSF – C-reactive protein were positive in 41%, Gramstain were positive in 67%, LAT in 78% and culture positive in 50% of cases.5
In a study conducted in MaulanaAzadMedicalCollege in 2005, out of 65 cases of clinically diagnosed meningitis, culture were positive only in 15 cases. Of these 15 cases, Gram stain were positive in 11 cases. Latex agglutination test detected bacterial antigen in 10 cases of bacterial meningitis. Two culture negative specimens were positive with latex agglutination test. 6
In a study conducted in kingdom of Saudi Arabia between June 1999 to May 2001. 208 cases of bacterial meningitis were identified, out of which Gramstain was positive in 97 (47.3%) cases. LAT were positive in 98 cases of 115 bacterial meningitis cases and were negative in all 67 aseptic meningitis cases. Culture of CSF were positive in 110 cases but negative in 28 bacterial meningitis and in all cases (67) of aseptic meningitis.7
6.3. Objectives of study:
i)To study the commonest organism’s in acute pyogenic meningitis.
ii)To study the antibiogram of the isolated pathogen.
iii)Comparison of C-reactive protein with Gram stain and culture.
iv)Comparison of latex agglutination test with Gram stain and culture.
7. / MATERIAL AND METHODS:
7.1 Source of data:
Study of 100 CSF samples of clinically suspected cases of acute pyogenic meningitis in paediatric department of Chigateri GeneralHospital and BapujiHospital attached to J.J.M.MedicalCollege Davangere.
7.2 Method of collection of data (including sample procedure if any)
Under all aseptic precautions lumbar puncture is done and cerebral spinal fluid is collected into a sterile container.
Inclusion criteria : Clinically suspected cases of acute pyogenic meningitis.
Exclusion criteria :Chronic pyogenic meningitis and aseptic meningitis.
Procedure :
1)The 2ml CSF sample collected under aseptic precautions in a sterile container was subjected to centrifugation at 1500 rpm for 10 minutes. After centrifugation, the supernatent was transferred to another test tube and used for serological test like latex agglutination test for bacterial antigens. The sediment was used for Gram’sstain and culture.
2)For culture, the CSF sample was inoculated on sheep blood agar, chocolate agar with isovitalex (X and V) factor and MacConkey’s agar.
3)Antibiotic sensitivity was done by Kirby Bauer’s disc diffusion method.
7.3. Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so describe briefly.
Yes
CSF samples has to be collected by lumbar puncture
7.4Has ethical clearance been obtained from your institution in case of 7.3?
Yes
8. / LIST OF REFERENCES:
  1. Viswanath G, Praveen, Hanumanthappa AR, Chandrappa NR, Mahesh BC. Bacteriological study of pyogenic meningitis with special reference to latex agglutination. Indian J Pathol Microbiol 2007;50(1):97-100.
  2. Mani R, Pradhan S, Nagarathna S, Wasiulla R, Chandramuki A. Bacteriological profile of community acquired acute bacterial meningitis : A ten-year retrospective study in a tertiary neurocare centre in South India. Indian J Med Microbiol 2007;25(2):108-14.
  3. Koneman. Part II : Guidelines for collection, transport, processing, analysis and reporting of cultures from specific specimen sources. Chapter 2. In: Koneman’s Colour Atlas and Textbook of Diagnostic Microbiology. 6th Edn., Lippincott Williams & Wilkins, Philadelphia1997;92-95.
  4. Hemvani N, Chitnis DS, Joshi SP. C-Reactive proteins in cerebro-spinal fluid and its role in differentiation of meningitis. Indian J of Med Microbiol 2001;19(1):26-29.
  5. Chinchankar N, Mane M, Bhave S, Bapat S, Bavdekar A, Pandit A et al. Diagnosis and outcome of acute bacterial meningitis in early childhood. Indian Pediatr 2002;39:914-921.
  6. Surinder K, Bineeta K, Megha M. Latex particle agglutination test as an adjunct to the diagnosis of bacterial meningitis. Indian J Med Microbiol 2007;25(4):395-7.
  7. Al-Mazrou YY, Musa EK, AbdallaMN, Al-Jeffri MH, Al-Hajjar SH, Mohamed OM. Disease burden and case management of bacterial meningitis among children under 5 years of age is Saudi Arabia. Saudi Med J 2003;24(12):1300-1307.

  1. Ogunlesi TA, Okeniyi JAO, Oyelami OA. Pyogenic meningitis in ilesa, Nigeria. Indian Pediatr 2005;42October(17):1019-1023.
  2. Leimkugel J, Forgor AA, Gagneux S, Pfluger V, Flierl C, Awine E. An outbreak of serotype 1 streptococcus pneumoniae meningitis in northern Ghana with features that are characteristic of Neisseria meningitidis Meningitis epidemics. JID 2005;192July(15):192-199.
  3. Sachdeva A, Kukreja S, Jain V, Dutta AK. Meningococcal disease – outbreak in Delhi. Indian Pediatr 2005;42June(17):547-555.

9. / SIGNATURE OF CANDIDATE
10. / REMARKS OF THE GUIDE
11. / NAME AND DESIGNATION OF
(IN BLOCK LETTERS)
11.1 Guide
11.2 Signature
11.3 Co-Guide (If any)
11.4 Signature
11.5 Head of Department
11.6 Signature /

Dr. VISWANATH G.

PROFESSOR,
DEPARTMENT OF MICROBIOLOGY,
J.J.M.MEDICALCOLLEGE,
DAVANGERE – 577 004.
Dr. N.R. CHANDRAPPA, M.D.
PROFESSOR AND HEAD,
DEPARTMENT OF MICROBIOLOGY,
J.J.M.MEDICALCOLLEGE,
DAVANGERE – 577 004.
12. / 12.1 Remarks of the Chairman
and Principal
12.2 Signature.