Length of prediagnostic history related to the course and sequelae of childhood bacterial meningitis

Kilpi, Terhi; Anttila, Marja; Kallio, Markku; Peltola, Heikki

doi:10.1097/00006454-199303000-00002

Cited by 38 publications

(22 citation statements)

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“…However, if the organism was identified as S. pneumoniae, treatment with antimicrobial agents prior to a diagnosis had a substantial benefit on outcome in terms of a reduced rate of meningitis-related complications (OR, 0.14; P = 0.02), although the reasons for this substantial treatment effect are unclear. These results conflicted with previously published studies in which either no differences in outcome, or a worse outcome, were observed in patients with bacterial meningitis who had previously been treated with antimicrobial therapy [14][15][16][17].…”

Section: Review Of the Literaturecontrasting

confidence: 99%

Timing of administration of antimicrobial therapy in bacterial meningitis

Short

Tunkel

2001

Curr Infect Dis Rep

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Bacterial meningitis is an important cause of morbidity and mortality in the United States and throughout the world. The diagnosis of bacterial meningitis is often delayed in patients as a result of numerous factors such as length of illness, use of radiologic imaging studies, and/or prior use of antimicrobial agents. Many textbooks emphasize the need for prompt initiation of antimicrobial therapy in a patient with suspected acute bacterial meningitis to prevent many of the long-term sequelae associated with this disorder. We have reviewed the literature to determine if there is a standard of care for timing of administration of antimicrobial therapy in patients with a diagnosis of acute bacterial meningitis. Although the clinical data are inconclusive, it makes intuitive sense to initiate antimicrobial therapy as soon as possible in any patient with suspected or proven bacterial meningitis before the patient's illness advances to a high level of clinical severity, beyond which antimicrobial therapy is less likely to be of benefit. However, clinical experiences suggest that patient outcome in bacterial meningitis is a result of multiple factors, since some patients treated within a few hours of symptoms develop an adverse outcome whereas others who are symptomatic for days prior to presentation suffer no adverse sequelae.

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Section: Review Of the Literaturecontrasting

confidence: 99%

Timing of administration of antimicrobial therapy in bacterial meningitis

Short

Tunkel

2001

Curr Infect Dis Rep

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“…Reports of the effect of delay in treatment on hearing outcome differ (9,10,12,16,19,27,28). If children with histories >7 days are excluded, as the symptoms were non-specific and may be unrelated to the onset of meningitis, we found a non-significant increase in incidence of hearing loss in those with a longer history of fever (50% vs. 36%, p = 0.13).…”

Section: Discussionmentioning

confidence: 70%

“…If children with histories >7 days are excluded, as the symptoms were non-specific and may be unrelated to the onset of meningitis, we found a non-significant increase in incidence of hearing loss in those with a longer history of fever (50% vs. 36%, p = 0.13). Radetsky and Kilpi found that the length of history of non-specific signs and symptoms did not correlate with outcome (27,28).…”

Section: Discussionmentioning

confidence: 99%

Hearing loss in Malawian children after bacterial meningitis: incidence and risk factors

Forsyth¹,

Kalumbi

Mphaka

et al. 2004

Audiological Medicine

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We had an objective to describe the incidence and risk factors for hearing loss following acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. A double-blind placebo-controlled trial was designed from July 1997-March 2001 to determine whether early steroid therapy would reduce overall mortality and morbidity in childhood bacterial meningitis. The QECH, Blantyre, Malawi is a teaching and referral public hospital that serves the Blantyre area and receives referrals from throughout southern Malawi. Participants were children aged 2 months to 13 years, admitted with a diagnosis of bacterial meningitis, and the main outcome measures were mortality and morbidity following bacterial meningitis. Three hundred and ninety-nine of 598 (66.7%) children survived; 33.6% were due to S. pneumoniae, 30% to Haemophilus influenzae type b, 15% to Neisseria meningitides, and 16% had no growth on CSF culture. Two hundred and sixty-eight (67%) survivors had reliable hearing tests of whom 38% had impaired hearing, 77% of which was bilateral. Independent risk factors for hearing loss were the causative agent, presentation with a low coma score (52% vs. 34%, p = 0.006), a first CSF sample with a positive Gram stain for bacteria (65% vs. 44.3%, p = 0.003), a WBC < 100/cmm (p = 0.01), or a high protein level (50% if > 2000 mg/dl vs. 11% if <100 mg/dl). Associated neurological sequelae were highly associated with hearing impairment (p = 0.000012). We conclude that bacterial meningitis is the cause of many children's hearing impairment. Immunization against S. pneumoniae and H. influenzae would prevent many cases. Better first line antibiotics may reduce audiological damage. Deaf children in poorer parts of the world need more and vocal advocacy.

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“…Iako su mišljenja o terapijskoj efikasnosti deksametazona kontraverzna rezultati kliničkih studija koje su objavljene u toku poslednjih 15 godina ukazuju na povoljan uticaj ovog leka na krajnji ishod oboljenja, pre svega u smanjivanju ukupnog mortaliteta i drugih neuroloških sekvela. Maksimalni terapijski efekat se postiže ako se lek da 15 do 20 minuta pre prve parenteralne doze antibiotika [16].…”

Section: Diskusijaunclassified

The use of antibiotics and their influence on course and outcome of bacterial meningitis in children before diagnosing it

Čukalović¹,

Ikatanic²,

Odalović³

2014

Praxis Med

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Bakterijski meningitis je teško infektivno oboljenje, izazvano različitim bakterijama, u toku koga dolazi do stvaranja gnojnog eksudata u subarahnoidnom prostoru. Klinički se ispoljava pojavom meningealnih simptoma i znakova. I pored neospornih uspeha koji se poslednjih godina postižu u lečenju bakterijskog meningitisa, ni najbolje organizovana terapija ne obezbeđuje povoljnu prognozu u sve obolele dece. Naše istraživanje obuhvatilo je 91 dete оbolelo od bakterijskog meningitisa. Antibiotsku terapiju pre postavljanja dijagnoze bakterijskog meningitisa dobijalo je 50 (54,9%) pacijenata. U ovoj grupi 21 bolesnik (42%) je ispoljio komplikacije bolesti koje su se manifestovale kod 13 (26%) bolesnika konvulzijama. Potpuni oporavak posle završenog lečenja imalo je u ovoj grupi 29 pacijenata (58%), a kod 8 pacijenata (16%) zabeležene su sekvele. Kod 41 (45%) pacijenta koji su bili bez prethodne antibiotske terapije komplikacije se registruju kod 25 (60,9%) pacijenata: rane komplikacije su se ispoljile kod 18 pacijenata(43,9%) ), a sa sekvelama je bilo 7 (17,1%). Potpuno izlečenje u ovoj grupi ispitanika bilo je 16(39%).Komplikacije i sekvele su bile prisutnije u grupi obolele dece koja nisu primala antibiotsku terapiju pre postavljanja konačne dijagnoze bakterijskog meningitisa. Međutim, prisustvo sekvela i u grupi dece koja su dobila antibiotsku terapiju pre završene dijagnostike ukazuje na potrebu da se insistira da lečenje bakterijskog meningitisa učini još efikasnijim i da započinjanje antibiotske terapije nakon potpune obrade pacijenta koja mora biti rana.Ključne reči: bakterijski meningitis,antibiotsko lečenje, deca. UVODMeđu bakterijskim infekcijama centralnog nervnog sistema, meningitis predstavlja najčešće oboljenje. Ostale piogene infekcije, kao što su moždani apsces, subduralni empijem i infekcija i tromboza intrakranijalnih venskih sinusa, javljaju se znatno ređe u dečjem uzrastu. Iako su poslednje dve decenije obeležene značajnim otkrićem u oblasti patofiziologije i patogeneze bakterijskog meningitisa, a terapijski arsenal obogaćen je novim antimikrobnim lekovima sa baktericidnim dejstvom, bakterijski meningitis predstavlja i dalje značajan uzrok morbiditeta i mortaliteta u dečjem uzrastu, pogotovu u zemljama u razvoju. Rano prepoznavanje bolesti i primena adekvatne terapije su bitan uslov za dobru prognozu [1].Bakterijski meningitis u 90%slučajeva javlja se u toku prvih pet godina života, pri čemu su novorođenčad izložena najvećem riziku da obole od ove bakterijske infekcije.Incidencija bakterijskog meningitisa kod novorođenčadi iznosi 0,1 do 0,4: 1000 (kod prevremeno rođenedec od 1,4 do 4:1000), a kod odojčadi i veće dece od 5,4 do 7,3: 100 000. U zrastu do 5 godina javlja se 80% slučajeva [2]. Najčešći uzročnici su Haemophilus influezae, Streptococcus pneumoniae i Neisseria meningitidis. Ostali značajni uzročnici su Streptococcus gr. B, Listeria monocytogenes, E. colli, Salmonella i druge gram negativne bakterije. U uzrastu do 5 godina najčešći uzročnik je H. influenzae (55%), a kasnije pneumokok i meni...

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Length of prediagnostic history related to the course and sequelae of childhood bacterial meningitis

Cited by 38 publications

References 0 publications

Timing of administration of antimicrobial therapy in bacterial meningitis

Timing of administration of antimicrobial therapy in bacterial meningitis

Hearing loss in Malawian children after bacterial meningitis: incidence and risk factors

The use of antibiotics and their influence on course and outcome of bacterial meningitis in children before diagnosing it

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