Are Pathogenic Leptospira a Possible Cause of Aseptic Meningitis in Suspected Children in Sudan?

Nada Abdelghani Abdelrahim; Imad Mohammed Fadl-Elmula; Rudy A Hartskeerl; Ahmed Ahmed; Marga Goris

doi:10.2147/RRTM.S339058

Are Pathogenic Leptospira a Possible Cause of Aseptic Meningitis in Suspected Children in Sudan?

Res Rep Trop Med. 2021 Dec 30:12:267-274. doi: 10.2147/RRTM.S339058. eCollection 2021.

Authors

Nada Abdelghani Abdelrahim¹, Imad Mohammed Fadl-Elmula², Rudy A Hartskeerl³, Ahmed Ahmed³, Marga Goris³

Affiliations

¹ Department of Medical Microbiology, Faculty of Medical Laboratory Sciences, Nile University, Khartoum, Sudan.
² Department of Pathology & Clinical Genetics, Al-Neelain University and Assafa Academy, Khartoum, Sudan.
³ OIE and National Collaborating Centre for Reference and Research on Leptospirosis, Department of Medical Microbiology, Academic Medical Center, Amsterdam, Netherlands.

Abstract

Introduction: Clinical presentations of leptospirosis are diverse, with meningitis easily confused with other microbial causes. We aimed to investigate the involvement of pathogenic leptospira in the cerebrospinal fluid (CSF) of meningitis-suspected children in Sudan.

Methods: A total of 153 CSF specimens were collected over 5 months from patients attending a reference pediatric hospital in Omdurman, Sudan. All patients had provisionally been diagnosed with meningitis on admission. Demographic, clinical, and conventional laboratory findings were obtained. DNA was extracted using a QIAamp mini kit, and the secY gene investigated using real-time PCR.

Results: Nine of 153 (6%) CSF specimens were positive for pathogenic leptospiral DNA. All these patients were male (seven infants and two toddlers aged ˂4 years). Typical conventional laboratory findings for aseptic meningitis (ie, CSF turbidity/pleocytosis, normal or reduced CSF glucose, normal or elevated proteins) were seen in five (56%). All patients presented with fever and seizures, 56% vomiting and stiff neck, and 29% bulging fontanel. Most (67%) patients presented in summer (March to May). Polymicrobial infections were identified in three patients (33%).

Conclusion: We conclude that pathogenic leptospira are probably a common cause of meningitis in children in Sudan; therefore, we recommend including leptospirosis in the differential diagnosis of CNS infections and other undifferentiated febrile illnesses in this country.

Keywords: Africa; PCR; infectious meningitis; leptospirosis; pediatrics.

Grants and funding

Molecular laboratory investigations were fully funded by the OIE and National Collaborating Centre for Reference and Research on Leptospirosis, Department of Medical Microbiology, Academic Medical Center, Amsterdam, Netherlands.