Epidemiological, clinical and prognostic profile of childhood acute bacterial meningitis in a resource poor setting

Abstract

Background:Childhood bacterial meningitis is a neurologic emergency that continues to kill and maims children particularly in developing countries with poor immunization coverage.Objective:This study set out to assess the hospital incidence, pattern of presentation, etiologic agents, outcome and determinants of mortality among the children admitted with bacterial meningitis at the Wesley Guild Hospital (WGH), Ilesa.Patients and Methods:We carried out a retrospective review of admitted cases of bacterial meningitis in children aged one month to 15 years at the WGH, Ilesa over a three year period by looking at the hospital records. Factors in the history and examinations were compared among survivors and those that died to determine factors significantly associated with mortality in these children.Results:Eighty-one (5.5%) of the 1470 childhood admissions during the study period had bacterial meningitis. Male preponderance was observed and two-thirds of the children were infants. More cases were admitted during the wet rainy season than during the dry harmattan season. Haemophilus influenzae type B and Streptococcus pneumoniae were the leading etiologic agents and ciprofloxacin and ceftriaxone adequately cover for these organisms. Twenty-two (27.2%) of the 81 children died, while 34 (42.0%) survived with neurologic deficits. Children with multiple seizures, coma, neck retraction, hyponatremia, hypoglycorrhachia, turbid CSF as well as Gram positive meningitis at presentation were found to more likely to die (P < 0.05). None of these factors however independently predict mortality.Conclusion:Childhood bacterial meningitis often results in death and neurologic deficit among infants and young children admitted at the WGH, Ilesa. Children diagnosed with meningitis who in addition had multiple seizures, neck retraction and coma at presentation are at increased risk of dying.

Acute Bacterial Meningitis in Children Before and After Pneumococcal Vaccine in Pakistan National Immunization Programme; A Comparison

“…Similar results were seen with 24% complications rate in a study published in Arch Dis Child 18. A few studies reported a much higher percentage of complications as compared to our study (39%, 42%) 3,10…”

“…Our results were comparable with, studies done by Nhantumbo and Rajani in which CSF culture showed positivity in 7.3% and 7.2% respectively 12,13. A much higher percentage of 62.7% CSF culture positivity was reported in another study published in J Neurosci Rural Practice 3. A much high proportion (88% and 93.4%) of all meningitis cases in our study grew no bacterial pathogen.…”

Bacterial and Viral Investigation of Cerebrospinal Fluid Samples in Patients With Suspected Encephalitis / Meningitis In a University Hospital

“…Akut bakteriyel menenjit çocuklarda ve yenidoğan bebeklerde dünya genelinde önemli bir sağlık sorunu olduğundan erken tanı konarak acil tedavi edilmesi gerekmektedir (2,3,9) . Bazı gelişmekte olan ülkelerde, akut bakteriyel menenjitin mortalite oranı yeni ve etkili antibiyotikler bulunmasına rağmen hâlâ çok yüksektir (%16-32) (9)(10)(11) .…”

“…Bakteriyel menenjite sıklıkla neden olan etkenler arasında Streptococcus pneumoniae, Neisseria meningitidis ve Haemophilus influenzae type b'nin olduğu bildirilmektedir (2,3) . Ancak menenjit patojenlerinin prevalansı ve menenjit etiyolojisi, hastaların yaşı, coğrafi bölgeler, mevsim, popülasyonun belirli etkenlere karşı duyarlılığı, genetik yapı, sosyoekonomik koşullar ve lokal endemik faktörlere bağlı olarak göre değişkenlik gösterebilir (1) .…”

Etiology and outcome of culture proven bacterial meningitis in children 6 to 24 months of age.

“…The study done by Levy C et al in 2014 5 showed mortality 10.6% after the introduction of routine vaccination. The study done by Kuti BP et al in 2015 6 in Nigeria, where vaccination is very poor showed commonest bacteria H. influenza type b and S. pneumonia while mortality was 27.2%. The studies done in various parts of Pakistan showed highly variable mortality from study to study ranging from 1.67-34%.…”