Clinical features of bacterial meningitis among hospitalised children in Kenya

Abstract

Background Diagnosing bacterial meningitis is essential to optimise the type and duration of antimicrobial therapy to limit mortality and sequelae. In sub-Saharan Africa, many public hospitals lack laboratory capacity, relying on clinical features to empirically treat or not treat meningitis. We investigated whether clinical features of bacterial meningitis identified prior to the introduction of conjugate vaccines still discriminate meningitis in children aged ≥60 days. Methods We conducted a retrospective cohort study to validate seven clinical features identified in 2002 (KCH-2002): bulging fontanel, neck stiffness, cyanosis, seizures outside the febrile convulsion age range, focal seizures, impaired consciousness, or fever without malaria parasitaemia and Integrated Management of Childhood Illness (IMCI) signs: neck stiffness, lethargy, impaired consciousness or seizures, and assessed at admission in discriminating bacterial meningitis after the introduction of conjugate vaccines. Children aged ≥60 days hospitalised between 2012 and 2016 at Kilifi County Hospital were included in this analysis. Meningitis was defined as positive cerebrospinal fluid (CSF) culture, organism observed on CSF microscopy, positive CSF antigen test, leukocytes ≥50/μL, or CSF to blood glucose ratio <0.1. Results Among 12,837 admissions, 98 (0.8%) had meningitis. The presence of KCH-2002 signs had a sensitivity of 86% (95% CI 77–92) and specificity of 38% (95% CI 37–38). Exclusion of ‘fever without malaria parasitaemia’ reduced sensitivity to 58% (95% CI 48–68) and increased specificity to 80% (95% CI 79–80). IMCI signs had a sensitivity of 80% (95% CI 70–87) and specificity of 62% (95% CI 61–63). Conclusions A lower prevalence of bacterial meningitis and less typical signs than in 2002 meant the lower performance of KCH-2002 signs. Clinicians and policymakers should be aware of the number of lumbar punctures (LPs) or empirical treatments needed for each case of meningitis. Establishing basic capacity for CSF analysis is essential to exclude bacterial meningitis in children with potential signs.

Can Clinical Presentations or Hematological Indices Predict Meningitis in Febrile Children?

“…While in outbreaks from other regions like Ghana, children of age range 10-14 was mostly affected in meningitis outbreak [15] .The mean age of febrile patients with proved meningitis was higher than those with negative CSF analysis. This indicates that from febrile patients in whom CSF analysis was requested based on clinical presentation, meningitis tend to affect older age patients this could be attributed to the fact that signs of meningitis in young patients is not specific which results in over requesting lumbar puncture in young age children [16][17][18]. There is a robust evidence link residence in rural areas with development of meningitis during an outbreak [19][20][21] and this was evident in this study as children diagnosed with meningitis in this study during meningitis outbreak were significantly resides in rural area (P value=0.014).…”

investigation on the prevalence of complication of bacterial meningitis and its related factors in children after the neonatal period- a retrospective study.

“…Despite the continuous progress in the eld of antibiotics, the burden of complications and death is still high for bacterial meningitis in children, as this is related to several factors. Bacterial meningitis is a major challenge, especially in low-and middle-income countries (5). This retrospective study aims to investigate the prevalence of complications caused by bacterial meningitis and its associated factors in children and infants' post-neonatal period, admitted to Damascus Hospital.…”