Severity of childhood bacterial meningitis and duration of illness before diagnosis

The clinical presentation of acute bacterial meningitis varies with age, sex and duration of illness

“…In our study, the mean age on admission was four years and two months, which is consistent with what has previously been reported from Sweden (3,4). International comparisons show that Sweden has a relatively high mean age and a relatively low incidence rate for acute bacterial meningitis in childhood (5,6). This difference can be attributed to a high breastfeeding rate in Sweden, which protect children and enhances their immune system (12)(13)(14).…”

“…This means that if medical attention is sought for patients within the first 24 hours, they might have a more severe infection because of a more virulent pathogen, a higher load of pathogens, a stronger inflammatory reaction or a higher susceptibility to infection. This conclusion was supported by an article published in The Lancet in 1991, which showed that patients with symptoms that lasted 24 hours or less on admission had a worse outcome, with higher morbidity and mortality (6).…”

“…CSF tests showed that boys had higher CSF levels of monocytes and higher CSF levels of protein, levels that are normally equal for boys and girls (17,18). Higher protein CSF levels, a known negative prognostic factor, indicate an increased disturbance and permeability of the blood-brain barrier, caused by inflammation (5,6,17,18). This can result in vasogenic cerebral oedema, which raises intracranial pressure, and this, in turn, can lead to herniation of the brain or cause a reduction of cerebral blood flow with ischaemia, which can both cause neurological damage and death (1,(19)(20)(21)(22).…”

“…In a study by Rennick et al, herniation was seen in 45% of all fatal cases of meningitis (23). In cases of acute bacterial meningitis, death can also be caused by septicaemia resulting in multi-organ failure and respiratory or circulatory failure (5,6), and septicaemia is also the main cause of death in children with meningococcal meningitis (24). For pneumococcal and Hib meningitis, the main cause is death due to neurological complications (1,2,25).…”

“…Boys have a higher case fatality rate for acute bacterial meningitis than girls, but there is less information on differences in clinical presentation and laboratory findings due to the patient's sex (5,6).…”