Intensive care needs of children with acute bacterial meningitis: a developing country perspective

Abstract

In view of very limited availability of paediatric intensive care (PIC) facilities in developing countries, it is important to define priorities and recognise children who might benefit most from PIC. The objective of this retrospective, descriptive analysis was to identify the clinical indicators for intensive care in children with acute bacterial meningitis (ABM). The study included 220 children aged between 1 month and 12 years with ABM admitted to the paediatric services of an urban, tertiary-care, teaching hospital in northern India from July 1993 to December 1996. Of these, 88 were transferred to the PICU by the primary physician, 59% were comatose (Glasgow coma score <8), 44% had raised intracranial pressure (ICP), 24% were in shock and 42% had respiratory distress/failure. Seizures occurred during their illness in 64 children, 34 of whom had refractory status epilepticus. Endotracheal intubation was needed in 29 and ventilatory support in 19 children. Most of the life support measures were required during the initial 48 hours. Nineteen (22%) children died, 16 of whom were comatose on admission. Multiple system involvement was associated with higher mortality. There were no deaths among the children who were not transferred to the PICU. Children with ABM who have a Glasgow coma score <8, clinical signs of raised ICP, refractory status epilepticus, shock and/or respiratory compromise should be prioritised to receive PIC.

Recovery of consciousness following acute symptomatic seizures due to central nervous system infections in children

“…Our study shows that seizures occur in almost half of children with CNS infections and differ in their ictal and postictal course from seizures of other aetiologies, in that status epilepticus, requirement for intubation, and, in those not intubated, a prolonged duration in the postictal recovery of consciousness are more likely. A study from India also found a high rate of status epilepticus in children with bacterial meningitis, 4 and Chin et al 5 recommended a high index of suspicion for acute bacterial meningitis in children with first-ever episodes of convulsive status epilepticus. CNS infection should be considered in all children with unexplained status epilepticus.…”

Serum cortisol levels in children with acute bacterial and aseptic meningitis

“…Children with bacterial meningitis are generally critically ill and need intensive care (1). There is increasing evidence of reversible adrenal insufficiency in critically ill patients with sepsis (2, 3), but there is very little published data on cortisol response in children with bacterial meningitis, other than in children with severe meningococcal meningitis (4 -6).…”

Clinical Microbiological Aspects of Epileptic Seizures in the Tropical Countries with Specific Focus on Nigeria

“…Convulsions are common complications of shigellosis in children [8,17]. Other infected individuals may show refractory status epilepticus, shock [9,18], and epileptic seizures revealing a menses toxic shock syndrome have also been reported [10].…”

“…It is also suggested that the causative agents of febrile illness associated with seizures in summer season are primarily enteroviruses, especially coxsackieviruses group A and that febrile seizures might be caused by enteroviral infection in the central nervous system [15,16,17,18,19,34]. Alterations in consciousness, including seizures, delirium, and coma are known to occur during Shigella infection.…”