Skip to main content Accessibility help
×
Home

Outbreak of meningococcal disease in and around New Delhi, India, 2005–2006: a report from a tertiary care hospital

  • D. NAIR (a1), R. DAWAR (a1), M. DEB (a1), M. R. CAPOOR (a1), S. SINGAL (a2), D. J. UPADHAYAY (a2), P. AGGARWAL (a1), B. DAS (a3) and J. C. SAMANTARAY (a3)...

Summary

The first of several cases of meningococcal meningitis was reported in April 2005, in New Delhi, India. Subsequent to this the Government declared an outbreak, which persisted for two periods, from April–July 2005 and January–March 2006. The National Institute of Communicable Diseases (NICD) recommended using WHO criteria for diagnosis of disease. During the outbreak 380 clinically suspected cases were investigated. Of 55 cases diagnosed as confirmed/probable the mortality rate was 14·6%. Meningitis was reported in 60% of cases and meningococcaemia in 40%. Microscopy of petechial rash was positive in 87·5%, CSF Gram stain positive in 68·3%, and latex agglutination test of CSF positive in 64·9% of samples. Neisseria meningitidis (serogroup A) was isolated from 37·7% of cases, 57·7% from CSF. Blood culture was positive in 10·4% of cases. CrgA polymerase chain reaction for N. meningitidis confirmed the isolates. All isolates were susceptible to third-generation cephalosporins, azithromycin and rifampicin, with increasing resistance to ceftriaxone. Penicillin resistance was encountered in 15·4% of strains. Resistance to quinolones was very high at 100% for levofloxacin, 84·6% for ofloxacin and 65·4% for ciprofloxacin. All patients with penicillin-resistant organisms (4) or intermediate sensitivity (4) succumbed to the disease. These patients also had a higher minimum inhibitory concentration to ceftriaxone.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Outbreak of meningococcal disease in and around New Delhi, India, 2005–2006: a report from a tertiary care hospital
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Outbreak of meningococcal disease in and around New Delhi, India, 2005–2006: a report from a tertiary care hospital
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Outbreak of meningococcal disease in and around New Delhi, India, 2005–2006: a report from a tertiary care hospital
      Available formats
      ×

Copyright

Corresponding author

*Author for correspondence: Dr D. Nair, D-II/2201, Vasant Kunj, New Delhi 110070, India. (Email: deepthinair2@gmail.com)

References

Hide All
1. Janda, WM, Knapp, JS. Neisseria and Moraxella catarrhalis. In: Murray, PR, Baron, EJ, Jorgensen, JH, Pfaller, MA, Yolken, RH eds. Manual of Clinical of Microbiology, 8th edn. Washington, DC: ASM Press, 2003 585, pp. –608.
2. Raja, NS, et al. Invasive meningococcal disease in the university of Malaya Medical Centre, Kuala Lumpur, Malaysia. Journal of Postgraduate Medicine 2006: 52: 2329.
3. World Health Organization. Communicable Disease Department, WHO Regional Office for South East Asia. Meningococcal disease in India, Epidemic and Pandemic Alert response (EPR), CD Alert 2005.
4. Taha, MK, et al. Circumvention of herd immunity during an outbreak of meningococcal disease could be correlated to escape mutation in the porA gene of Neisseria meningitidis. Infection & Immunity 2001; 169: 19711973.
5. Manchanda, V, Gupta, S, Bhalla, P. Meningococcal disease: history, epidemiology, pathogenesis, clinical manifestations, diagnosis, antimicrobial susceptibility and prevention. Indian Journal of Medical Microbiology 2006; 24: 719.
6. Singhal, S, et al. Ciprofloxacin resistant Neisseria meningitidis, Delhi, India. Emerging Infectious Diseases 2007; 13: 16141616.
7. CDC. Case definitions for infectious conditions under public health surveillance. Morbidity and Mortality Weekly Report 1997; 46: RR-10.
8. Vazquez, JA, et al. Interlaboratory comparison of agar dilution and E test methods for determining the MICs of antibiotics used in management of Neisseria meningitidis infections. Antimicrobial Agents and Chemotherapy 2003; 47: 34303434.
9. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI document (M100-S16), Vol. 26, Clinical and Laboratory Standards Institute, 2007. Wayne, Pennsylvania.
10. Taha, MK. Simultaneous approach for nonculture PCR-based identification and serogroup prediction of Neisseria meningitidis. Journal of Clinical Microbiology 2000; 32: 855857.
11. Newcombe, J, et al. PCR of peripheral blood for diagnosis of meningococcal disease. Journal of Clinical Microbiology 1996; 34: 16371640.
12. Borrow, RH, et al. Non-culture diagnosis and serogroup determination of meningococcal B and C infection by a sialyltransferase (siaD) PCR ELISA. Epidemiology and Infection 1997; 118: 111117.
13. Sachdeva, A, et al. Meningococcal disease – outbreak in Delhi. Indian Pediatrics 2005; 42: 547555.
14. Tunkel, AR, et al. Practice guidelines for the management of bacterial meningitis. Clinical Infectious Diseases 2004; 39: 12671284.
15. Van Duren, M, Brandtzaeg, P, Van Dermeer, JWM. Update on Meningococcal disease with emphasis on pathogenesis and clinical management. Clinical Microbiology Reviews 2000; 13: 144166.
16. Periappuram, M, Taylor, MRH, Keane, CT. Rapid detection of meningococci from petechiae in acute meningococcal infection. Journal of Infection 1995; 31: 201203.
17. Lodder, MC, et al. Prognostic indicators of the outcome of meningococcal disease: a study of 562 cases. Journal of Medical Microbiology 1996; 45: 1620.
18. Reger, LE, Kunz, G. Neisseria meningitidis meningitis. The John Hopkins Microbiology Newsletter 2001; 20: 13.
19. Erdem, G, et al. False positive latex agglutination test with Neisseria meningitidis ACYW135 in a patient with intracranial dermoid. Pediatrics Infectious Disease Journal 1994; 13: 550551.
20. D'Amato, RF, Hochstein, L, Fay, EA. False-positive latex agglutination test for Neisseria meningitidis groups A and Y povidone-iodine antiseptic contamination of cerebrospinal fluid. Journal of Clinical Microbiology 1990; 28: 21342135.
21. Olcen, P, et al. Culture diagnosis of meningococcal carriers: yield from different sites and influence of storage in transport medium. Journal of Clinical Pathology 1979; 32: 12221225.
22. Pollard, AJ, et al. Meningococcal disease in British Columbia. BC Medical Journal 2001; 43: 2127.
23. Carrol, ED et al. Performance characteristics of the polymerase chain reaction assay to confirm clinical meningococcal disease. Archives of Diseases in Childhood 2000; 83: 271273.
24. Canada Communicable Disease Report. Neisseria meningitidis with decreased susceptibility to penicillin in Ontario, Canada 1997–2000 2001; 27: 14.
25. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI document (M100-S15) Clinical and Laboratory Standards Institute, 2005. Wayne, Pennsylvania.
26. Ayyagari, A, Dubey, ML, Bhandari, SK. Sulphadiazine resistant strains of Neisseria meningitidis during an outbreak of meningococcal meningitis. Indian Journal of Medical Research 1987; 85: 249252.
27. Basu, RN, Prasad, R, Ichhpujani, RL. Meningococcal meningitis in Delhi and other areas. Communicable Diseases Bulletin 1985; 2: 1.
28. Annapurna, ME, Bhave, GG, Mathur, M. An outbreak of meningitis caused by Neisseria meningitidis Group A. Journal of Communicable Diseases 1989; 21: 2426.
29. Tapsall, JW, et al. Surveillance of antibiotic resistance in invasive isolates of Neisseria meningitidis in Australia 1994–1999. Pathology 2001; 33: 359361.
30. Oppenheim, BA. Antibiotic resistance in Neisseria meningitidis. Clinical Infectious Diseases 1997; 24: S98S101.
31. Abadi, FJ, Yakubu, DE, Pennington, TH. In vitro activities of meropenem and other antimicrobial agents against British meningococcal isolates. Chemotherapy 1999; 45: 253257.
32. Jorgensen, JH, Crawford, SA, Fiebelkorn, KR. Susceptibility of Neisseria meningitidis to 16 antimicrobial agents and characterization of resistance mechanisms affecting some agents. Journal of Clinical Microbiology 2005; 43: 31623171.
33. Shultz, TR, Tapsall, JW, White, PA. An invasive isolate of Neisseria meningitidis showing decreased susceptibility to quinolones. Antimicrobial Agents and Chemotherapy 2000; 44: 1116.
34. Rainbow, J, et al. Rifampin-resistant meningococcal disease. Emerging Infectious Diseases 2005; 11: 977979.
35. Capoor, MR, et al. In vitro activity of azithromycin, newer quinolones and cephalosporins in ciprofloxacin resistant Salmonella causing enteric fever. Journal of Medical Microbiology 2007; 56: 14901494.
36. Mehta, G, Goyal, R. Emerging fluoroquinolone resistance in Neisseria meningitidis in India: cause for concern. Journal of Antimicrobial Chemotherapy 2007; 59: 329330.

Keywords

Outbreak of meningococcal disease in and around New Delhi, India, 2005–2006: a report from a tertiary care hospital

  • D. NAIR (a1), R. DAWAR (a1), M. DEB (a1), M. R. CAPOOR (a1), S. SINGAL (a2), D. J. UPADHAYAY (a2), P. AGGARWAL (a1), B. DAS (a3) and J. C. SAMANTARAY (a3)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed