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Recurrent meningitis in the pediatric patient--the otolaryngologist's role
D S Drummond1, A L de Jong, C Giannoni
1Baylor College of Medicine, Texas Children's Hospital, Houston, USA.
Insights
Recurrent meningitis in children often stems from Streptococcus pneumoniae infections. Investigations should include otolaryngologic and immunologic assessments to identify underlying causes in pediatric patients.
Area of Science:
- Pediatric infectious diseases
- Neurology
- Otolaryngology
Background:
- Recurrent meningitis presents a diagnostic challenge in pediatric patients.
- Identifying the underlying etiology is crucial for effective management and prevention of further episodes.
Observation:
- A retrospective review identified six pediatric cases of recurrent meningitis over an 11-year period.
- Streptococcus pneumoniae was the causative agent in 73% of identified meningitis episodes.
- Etiologies included temporal bone abnormalities, immunological deficiencies, and unknown causes.
Findings:
- One-third of recurrent meningitis cases had an otolaryngologic origin.
- A significant portion of patients required comprehensive investigations to determine the cause.
- The study highlights the importance of considering both otolaryngologic and immunologic factors.
Implications:
- Children with recurrent meningitis warrant thorough otolaryngologic evaluation.
- Immunological assessments are recommended for pediatric patients with recurrent meningitis of unknown etiology.
- CT scans of the temporal bones, skull base, and paranasal sinuses are advised for diagnosis.
Objective:
To assess the etiology of recurrent meningitis in the pediatric patient.
Design:
Retrospective case series and literature review.
Setting:
Tertiary-care pediatric hospital.
Patients:
Children (< 17-years-old) with recurrent meningitis, treated at Texas Children's Hospital (TCH) between 1984 and 1995.
Results:
A review of 463 cases of bacterial meningitis over an 11 year period revealed six children aged 3 months to 15 years with the diagnosis of recurrent meningitis. The patient's age, number of episodes of meningitis, diagnostic investigations performed and etiologies of recurrent meningitis were recorded. Fifteen episodes of meningitis were identified in these six patients; Streptococcus pneumoniae represented the bacteriology in 73% of the cases. Two patients were diagnosed with temporal bone abnormalities, two children with immunological deficiencies and no underlying etiology for the recurrent meningitis was identified in the remaining two patients. In this series, one-third of patients had an otolaryngologic etiology for their recurrent meningitis. These six patients, along with a review of the recent literature, will highlight the need for otolaryngological assessment and the importance of considering immunological investigations when managing recurrent meningitis in the pediatric patient.
Conclusion:
We propose that children with recurrent meningitis of unknown etiology undergo: (1) an audiological evaluation; (2) a CT scan of the temporal bones, skull base and paranasal sinuses; and (3) an immunological evaluation.