Journal of Antivirals & Antiretrovirals
Open Access

Abstract

Epidemiology of Different Types of Meningitis Cases in Gaza Governorates, Occupied Palestinian Territory, December 2013- January 2014

Nedal Ghuneim, Majdi Dheir and Khaled Abu Ali

Background: Meningitis remains one of the most significant infections in children. In Gaza Strip (GS), meningitis is endemic and the incidence is fluctuating from 22 to 94/100000 population. There was an outbreak of aseptic meningitis in 1997, 2004 and 2013 resulting in an elevation of the rate to higher than 100/100000.
Aim of the study: To determine and characterize the epidemiology of meningitis in GS in order to design adequate management, prevention and control strategies.
Methods and material: This study is a cross sectional descriptive study of meningitis in GS. From December 1, 2013 through January 31, 2014, data of all registered cases of meningitis in Ministry of Health pediatric hospitals were collected and analyzed. 20 cerebrospinal fluid samples (CSF) were sent to Norway through the institute of public health for viral study.
Results: During the study period, a total of 129 cases with meningitis were reported in GS. The majority of cases were male (57.4%) with a male:female ratio of 100: 74. The mean age was 28 months and infants were the most affected age group (48.8%). The majority of cases (62%) were diagnosed as non-specific meningitis and 38% as bacterial meningitis. The majority of CSF and blood cultures for bacteria were negative (96% and 97% respectively). 3 cases were diagnosed as Neisseria Meningitides by Gram staining. All these patients were hospitalized and received parenteral antibiotics. Out of 20 samples sent to Norway, seven samples (35%) were positive for enterovirus. No deaths were reported among all reported cases.
Discussion: However, we found in our study very large differences in CSF lab testing parameters with similar studies or even with the globally used cut-off between bacterial and aseptic meningitis. In GS except CSF culture no available lab tests for distinguishing different types of meningitis. Different statistical significant differences were found between the types of meningitis and different CSF or blood tests but it is not a reliable to differentiate the types of meningitis. These findings are due to the lack of a clear standard guideline for dealing with suspected cases of different types of meningitis and management of the disease.
Conclusion: Aseptic meningitis is the most prevalent type of meningitis in GS where children and infants are more at risk. No available unified and adequate standard guidelines for dealing with meningitis and the available CSF lab tests are not fully reliable for differentiation of meningitis types.