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[Acute bacterial meningoencephalitis in children. Complications and neurologic sequelae]
W Natalino1, M V Moura-Ribeiro
1Departmanto de Neuropsiquiatria e Psicologia Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Brasil.
Insights
This study on childhood bacterial meningoencephalitis found that prior antibiotic treatment (PT) was linked to more ventriculitis, while no prior treatment (NTP) allowed for easier etiological agent identification. Mortality was higher in infants.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurocritical Care
Context:
- Investigated 271 children under 15 diagnosed with acute bacterial meningoencephalitis.
- Study period: 1980-1990 at the University of São Paulo.
- Patients categorized into those with (PT) and without (NTP) previous antibiotic treatment.
Purpose:
- To analyze the impact of prior antibiotic treatment on the clinical presentation and outcomes of acute bacterial meningoencephalitis in children.
- To identify etiological agents and neurosurgical complications in relation to treatment history.
Summary:
- Etiological agents were more frequently identified in the NTP group (153 cases) compared to the PT group (118 cases).
- Ventriculitis was a more common complication in the PT group.
- Overall mortality was 19.5%, significantly higher (29.7%) in children under 12 months. Streptococcus pneumoniae infections correlated with increased mortality. Neurological sequelae included convulsive disorders and hemiparesis, particularly in infants. Neurosurgical interventions addressed ventriculitis, hydrocephalus, and brain abscesses.
Impact:
- Highlights the challenges in diagnosing bacterial meningoencephalitis when prior antibiotics are used.
- Underscores the increased risk of specific complications like ventriculitis and higher mortality in infants.
- Provides insights into neurosurgical management strategies for pediatric bacterial meningoencephalitis.
Abstract:
We studied 271 children under age of 15 with diagnosis of acute bacterial meningencephalitis treated at Medical School in Ribeirão Preto, University of São Paulo, between 1980 and 1990. The patients were divided in two groups: 1) those who had not received previous antibiotics treatment (NTP), with 153 cases; and 2), those who had received previous antibiotics treatment (PT), with 118 cases. The etiological agent was more frequently identified in NPT group, while ventriculitis was more frequent in PT group. Mortality rate accounted for 19.5% of all cases, and 29.7% of children under 12 months of age. Acute meningitis caused by Streptococcus pneumoniae was frequently followed by increased mortality. Convulsive disorders and hemiparesis predominante among children under 12 months of age. On the neurosurgical point of view, ventriculitis, subdural hygroma, hydrocephalus, subdural empyema and brain abscess were identified and treated.