title: Neisseria meningitidis and Streptococcus pneumoniae as leading causes of pediatric bacterial meningitis in nine Mexican hospitals following 3 years of active surveillance.
abstract: OBJECTIVE
  Meningococcal meningitis is reported as a rare condition in Mexico. There are no internationally published studies on bacterial causes of meningitis in the country based on active surveillance. This study focuses on finding the etiology of bacterial meningitis in children from nine Mexican Hospitals.
  
  
  METHODS
  From January 2010 to February 2013, we conducted a three years of active surveillance for meningitis in nine hospitals throughout Mexico. Active surveillance started at the emergency department for every suspected case, and microbiological studies confirmed/ruled out all potentially bacterial pathogens. We diagnosed based on routine cultures from blood and cerebrospinal fluid (not polymerase chain reaction or other molecular diagnostic tests), and both pneumococcal serotyping and meningococcal serogrouping by using standard methods.
  
  
  RESULTS
  Neisseria meningitidis was the leading cause, although 75% of cases occurred in the northwest of the country in Tijuana on the US border. Serogroup C was predominant. Streptococcus pneumoniae followed Neisseria meningitides, but was uniformly distributed throughout the country. Serotype 19A was the most incident but before universal implementation of the 13-valent pneumococcal conjugate vaccine. Other bacteria were much less common, including Enterobacteriaceae and Streptococcus agalactiae (these two affecting mostly young infants).
  
  
  CONCLUSIONS
  Meningococcal meningitis is endemic in Tijuana, Mexico, and vaccination should be seriously considered in that region. Continuous universal vaccination with the 13-valent pneumococcal conjugate vaccine should be nationally performed, and polymerase chain reaction should be included for bacterial detection in all cultures - negative but presumably bacterial meningitis cases.
authors.affiliation: Hospital General de Tijuana, Paseo Centario S/N, Zona del Rio, Tijuana, 22010, Mexico.
authors.forename: Enrique
authors.initials: E
authors.lastname: Chacon-Cruz
authors.affiliation: Hospital Universitario 'Dr. Jose Eleuterio Gonzalez,' Monterrey, Nuevo Leon, Mexico.
authors.forename: Cesar Adrian
authors.initials: CA
authors.lastname: Martinez-Longoria
authors.affiliation: Hospital Pediatrico de Sinaloa 'Dr. Rigoberto Aguilar Pico,' Culiacan, Sinaloa, Culiacan, Mexico.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Llausas-Magana
authors.affiliation: Hospital Civil de Guadalajara 'Fray Antonio Alcalde,' Guadalajara, Jalisco, Guadalajara, Mexico.
authors.forename: Antonio
authors.initials: A
authors.lastname: Luevanos-Velazquez
authors.affiliation: Hospital Infantil de Morelia 'Eva Samano de Lopez Mateos,' Morelia, Michoacan, Morelia, Mexico.
authors.forename: Jorge Alejandro
authors.initials: JA
authors.lastname: Vazquez-Narvaez
authors.affiliation: Hospital General 'Dr. Rafael Pascacio Gamboa,' Tuxtla Gutierrez Chiapas, Tuxtla Gutierrez, Mexico.
authors.forename: Sandra
authors.initials: S
authors.lastname: Beltran
authors.affiliation: Hospital de Pemex Picacho, Mexico City, Mexico City, Mexico.
authors.forename: Ana Elena
authors.initials: AE
authors.lastname: Limon-Rojas
authors.affiliation: Hospital para el Niño de Toluca, Edo. Mexico, Toluca, Mexico.
authors.forename: Fernando
authors.initials: F
authors.lastname: Urtiz-Jeronimo
authors.affiliation: Instituto Nacional de Pediatria, Mexico City, Mexico.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Castaneda-Narvaez
authors.affiliation: Instituto Nacional de Pediatria, Mexico City, Mexico.
authors.forename: Francisco
authors.initials: F
authors.lastname: Otero-Mendoza
authors.affiliation: Hospital Médica Sur, Mexico City, Mexico.
authors.forename: Fernando
authors.initials: F
authors.lastname: Aguilar-Del Real
authors.affiliation: Hospital Civil de Guadalajara 'Fray Antonio Alcalde,' Guadalajara, Jalisco, Guadalajara, Mexico.
authors.forename: Jesus
authors.initials: J
authors.lastname: Rodriguez-Chagoyan
authors.affiliation: Hospital General de Tijuana, Tijuana, Mexico.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Rivas-Landeros
authors.affiliation: Hospital General de Tijuana, Tijuana, Mexico.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Volker-Soberanes
authors.affiliation: Hospital Universitario 'Dr. Jose Eleuterio Gonzalez,' Monterrey, Nuevo Leon, Mexico.
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: Hinojosa-Robles
authors.affiliation: Instituto Nacional de Pediatria, Mexico City, Mexico.
authors.forename: Patricia
authors.initials: P
authors.lastname: Arzate-Barbosa
authors.affiliation: Hospital Infantil de Morelia 'Eva Samano de Lopez Mateos,' Morelia, Michoacan, Morelia, Mexico.
authors.forename: Laura Karina
authors.initials: LK
authors.lastname: Aviles-Benitez
authors.affiliation: Hospital Pediatrico de Sinaloa 'Dr. Rigoberto Aguilar Pico,' Culiacan, Sinaloa, Culiacan, Mexico.
authors.forename: Fernando Ivan
authors.initials: FI
authors.lastname: Elenes-Zamora
authors.affiliation: Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, New Orleans, LA, USA.
authors.forename: Chandra M
authors.initials: CM
authors.lastname: Becka
authors.affiliation: FIDEC, University of Miami, Miami, FL, USA.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ruttimann
keywords: active surveillance; bacterial meningitis; children; meningococcal meningitis; pneumococcal meningitis