Epidemiology and Etiology of Bacterial Meningitis in Iran: A Systematic Review and Meta-analysis

Background: Meningitis is a life-threatening disease that can manifest as acute, subacute, or chronic. This disease is characterized by various symptoms such as fever, nausea, and stiff neck. It can be caused by infectious (bacteria, viruses, fungi, and parasites) and non-infectious (drugs, neoplasms, and systemic diseases) agents. Bacterial meningitis, the deadliest type of meningitis, was the focus of this systematic review and meta-analysis, which aimed to examine the epidemiology and etiology of bacterial meningitis in Iran. Methods: PubMed (Medline), Scopus, Web of Science, and ProQuest were searched for English articles and the Scientific Information Database and Magiran for Persian articles up to January 25, 2024. A total of 2240 articles were screened, and 58 articles were selected. Then, 51 studies were included in the epidemiological analysis and 48 in the etiological analysis. Results: The pooled hospital-based prevalence of meningitis in Iran was 16.48%. Streptococcus pneumoniae was responsible for 27.89% of meningitis cases in Iran and was the main cause of bacterial meningitis. Other common bacteria included Haemophilus influenzae (15.96%), Staphylococcus epidermidis (15.88%), and Klebsiella pneumoniae (15.56%). Fever was observed in 89.37% of patients, while nausea, neck stiffness, vomiting, and headache were also common manifestations, affecting approximately half of the patients. Conclusion: These findings highlight the importance of vaccination, especially against pneumococcus, and improved diagnostic practices. The results also underscore the need for stronger surveillance systems and expanded population coverage to enhance public health interventions and reduce the burden of bacterial meningitis in Iran.