Group B streptococcal meningitis in children beyond the neonatal period in sub-Himalayan India.

Sir,

I presume that the actual prevalence of group B streptococcus (GBS) meningitis is higher than 16% reported by Chauhan et al.[1] This is based on the presence of an important methodological limitation. Chauhan et al.,[1] stated in their interesting study that 92.5% had received prior antibiotic treatment from some peripheral institutions before being referred to the tertiary care hospital. The gram staining and culture reports were negative in all their studied cases. Moreover, polymerase chain reaction (PCR) was not available for GBS. Ultimately, Chauhan et al.,[1] totally relied upon latex particle agglutination test (LPAT) to establish the diagnosis of GBS meningitis in their studied cohort. It is worthy to mention that the sensitivity and specificity of LPAT has been found to be 66.66 and 87.91%, respectively.[2] Moreover, gram staining and LPAT could detect 85% of cases of acute bacterial meningitis (ABM).[3] With the combination of gram staining, culture, and LPAT; 100% sensitivity and specificity could be achieved and they are more productive than any single test.[23] With the history of prior antibiotic administration, real-time PCR assay remains superior and the golden standard to firm diagnosis of ABM.[4] Considering that limitation, I presume that the actual magnitude of GBS meningitis was underestimated. Despite that limitation, Chauhan et al.,'s study[1] highlighted the importance of ongoing surveillance of GBS and triggered the need to delineate molecular characterization of GBS strains that might have implications for vaccine development strategies. With the absence of effective GBS vaccine currently, the protocol of universal culture-based screening at 35-37 weeks gestational age and intrapartum antimicrobial prophylaxis for GBS-colonized women has been recently proved in view of US experience to comprise a highly effective strategy to decrease the burden of subsequent infants’ GBS infections.[5] The implementation of such protocol need to be considered in India.