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[Pneumococcal meningitis in children. Review of 28 cases]
S Mencía Bartolomé1, J Casado Flores, C Marín Barba
1Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario del Niño Jesús, Universidad Autónoma de Madrid, Spain.
Insights
Pneumococcal meningitis in children causes significant death and disability, with deafness being a common sequela. Early detection of prognostic indicators like coma and CT scan alterations is crucial for better outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Pneumococcal meningitis (caused by Streptococcus pneumoniae) is a major cause of childhood morbidity and mortality.
- Understanding its epidemiological characteristics and prognostic indicators is vital for effective management.
Purpose of the Study:
- To describe the epidemiological features, clinical presentation, and prognostic factors of pneumococcal meningitis in children.
- To identify predictors of mortality and severe sequelae.
Main Methods:
- Retrospective study of 28 children diagnosed with pneumococcal meningitis between 1990 and 1999.
- Exclusion of children with prior immune deficits or antipneumococcal vaccination.
Main Results:
- The majority of patients (82%) were under 5 years old, with common symptoms including fever, vomiting, and irritability.
- Neurological signs included decreased consciousness (22 patients), seizures (15), and neck stiffness (12).
- Significant sequelae included deafness (28%), hemiparesis (14%), and hydrocephalus (7%); 14% of patients died. Coma and abnormal CT scans predicted death or deafness.
Conclusions:
- Pneumococcal meningitis remains a serious threat to children, leading to significant mortality and long-term disabilities like deafness.
- Prognostic indicators such as coma, CT scan abnormalities, seizures, and hypoglycorrhachia are associated with poor outcomes.
- The introduction of antipneumococcal conjugated vaccines is expected to drastically reduce the incidence of this infection.
Objective:
To describe the epidemiological characteristics, clinical features and prognostic indicators of pneumococcal meningitis in children admitted to a children's hospital in Madrid.
Patients And Methods:
We retrospectively studied 28 children with a diagnosis of pneumococcal meningitis based on identification of S. pneumoniae in the blood or cerebrospinal fluid between 1990 and 1999. None of the children had previous immunological deficit or had received antipneumococcal vaccine.
Results:
The mean age of patients was 2.7 +/- 2.9 years (range 2 months to 11 years). Eighty-two percent of the children were younger than 5 years old. Male to female ratio was 1:1. The most frequent signs on admission were fever (100%), vomiting (57%), headache and irritability (53%), and shock (10%). Neurologic findings were lowered level of consciousness in 22 patients (man Glasgow Coma Scale score 9.9 +/- 3.9): seizures in 15 (53%); neck stiffness in 12 patients (42%) and arreactive mydriasis in 9 patients (32%). Twenty patients (71%) required admission to the intensive care unit. On discharge 15 patients (53%) had no sequelae; 8 patients (28%) suffered deafness; 4 (14%) had hemiparesis; 2 (7%) had severe hydrocephalus and 1 patient (3.5%) had mental retardation. Four patients (14%) died. Findings with the strongest predictive value for death or deafness (p > 0.05) were coma and alterations in cranial computer tomography (CT). Seizures, alterations in electroencephalogram (EEG) and hypoglycorrhachia were also prognostic indicators for deafness (p < 0.05).
Conclusions:
Meningitis caused by S. pneumoniae is a significant cause of morbidity and mortality in children. Deafness is one of the most common and serious sequelae of pneumococcal meningitis. Sequelae were associated with coma, alterations in CT scan, seizures and hypoglycorrhachia. The new, antipneumococcal conjugated vaccine will confer effective prevention from the age of 2 months and will produce a dramatic decrease in the incidence of this serious infection.