Infectious Causes of Acute Meningoencephalitis Syndrome in Children: Insights from a Tertiary Care Hospital in Pakistan

Abstract

Background: Acute Meningoencephalitis Syndrome (AMES) remains a significant cause of morbidity and mortality in children worldwide, with diverse infectious etiologies varying by geography and resource availability. While vaccines have successfully reduced bacterial meningitis due to Streptococcus pneumoniae and Haemophilus influenzae type B (Hib) in developed regions, serotype replacement and antimicrobial resistance pose ongoing challenges. Objective: This study aimed to determine the frequency of infectious causes of AMES among children presenting to a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan, providing essential epidemiological insights to guide diagnostic and preventive strategies. Methods:  A cross-sectional study was conducted in the Department of Pediatrics at Lady Reading Hospital (LRH), Peshawar, from August 1, 2020, to January 31, 2021. 130 children aged 1–10 years with acute meningoencephalitis syndrome of ≤72 hours’ duration were enrolled. Lumbar puncture was performed for cerebrospinal fluid (CSF) analysis, and pathogens including Streptococcus pneumoniae, enterovirus, herpesvirus VI, Mycobacterium tuberculosis, Escherichia coli, and Group B Streptococcus were identified. Data were analyzed using Statistical Package for the Social Sciences version 23, with stratification by age, gender, and duration of symptoms. Results and Conclusion: The most commonly identified pathogen was enterovirus (23.1%), followed by Group B Streptococcus (19.2%), Escherichia coli (17.7%), and Streptococcus pneumoniae (16.9%). Herpesvirus VI was detected in 12.3% of cases, while Mycobacterium tuberculosis was the least frequent (3.8%). Male patients accounted for 73.1% of cases. Age stratification indicated higher infection rates among younger children (1–5 years), although no statistically significant differences were observed across age groups, gender, or symptom duration. Viral etiologies, particularly enteroviruses, remain the predominant cause of pediatric AMES, aligning with global trends. However, the considerable burden of bacterial infections underscores the continued need for improved vaccination coverage and antimicrobial stewardship. The low detection rate of Mycobacterium tuberculosis likely reflects diagnostic limitations rather than its true prevalence. These findings highlight the importance of early diagnosis, targeted treatment strategies, and enhanced surveillance to improve outcomes in pediatric acute meningoencephalitis syndrome cases.