Bacterial Meningitis: Still a Cause of High Mortality and Severe Neurological Morbidity in Childhood

Abstract

Among 121 cases of bacterial meningitis (age 2 months to 12 years; mean, 35 months) treated over a 3-year period, Neisseria meningitidis was the most common pathogen (33 per cent), then Haemophilus influenzae (32 per cent) and Streptococcus pneumoniae (15 per cent). In the H. influenzae group, 95 per cent were aged below 2 years. Overall mortality was 12 per cent: higher in the S. pneumoniae (17 per cent) and less common organism (21 per cent) groups. Neurological sequelae in 21 (20 per cent) of the 106 survivors included hearing impairment in 17 and quadriparesis in eight. Meningitis caused by S. pneumoniae contained a significantly higher proportion of children with neurological morbidity (P = 0.0128). The addition of dexamethasone treatment during the third year produced an apparent but not significant trend towards less mortality (P = 0.7568), fewer neurological sequelae (P = 0.3401) and less hearing impairment (P = 0.3903). Despite the availability of effective chemotherapy, bacterial meningitis will remain an important cause of high mortality and considerable morbidity.

Dexamethasone Aggravates Hippocampal Apoptosis and Learning Deficiency in Pneumococcal Meningitis in Infant Rats

“…Abbreviations CSF, cerebrospinal fluid DG, dentate gyrus MMP, matrix metalloproteinase PBN, alpha-phenyl-tert-butyl nitrone TACE, tumor necrosis factor alpha converting enzyme Inflammation in the subarachnoid and ventricular space is the hallmark of bacterial meningitis and appears to be responsible for much of the pathophysiologic consequences of the disease (1)(2)(3). Therapy with highly active antibiotics is only partially effective in preventing death and the development of neurologic sequelae in patients with bacterial meningitis (4,5). Even with optimal treatment, mortality remains high in certain patient groups and up to 40% of the survivors of meningitis suffer from neurologic sequelae, including sensory-motor deficits, cerebral palsy, seizure disorders, mental retardation, and learning impairments (6 -8).…”

Predictors of Bacterial Meningitis in Resource-Limited Contexts: An Angolan Case

“…In Africa annually more than 1 million patients acquire meningitis: 350000 die and at least 30% of survivors are left with sequelae [5]–[6]. The incidence of BM is lower in industrialized countries than in low-income countries, with a difference in incidence and mortality of 10 times [6]–[11]. The main etiological agent of BM in Africa in infants from 0 to 5 years has been Hib, followed by Streptococcus pneumoniae and Neisseria meningitidis [2].…”

Etiologia de meningites bacterianas em uma amostra da população de Salvador - Bahia

“…Em uma revisão de 4100 casos do Hospital Couto Maia, em Salvador, Bahia, a incidência foi de 45,8 casos por 100000 habitantes, com uma letalidade global de 33% 8 . Sequelas podem ocorrer, por vezes incapacitantes 3,12,20 . Na década atual, diversos países conseguiram reduzir muito a prevalência de meningites bacterianas na população, implantando o uso rotineiro da vacina conjugada para H. influenzae tipo b 1,11,21,23,25,26 .…”