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Prognostic factors in children with purulent meningitis in Turkey
Ercan Kirimi1, Oğuz Tuncer, Sükrü Arslan
1Department of Pediatrics, Yüzüncü Yil University School of Medicine, Van, Turkey. ercankirimi@hotmail.com
Insights
Prognostic factors for childhood purulent meningitis in developing countries include anemia, low CSF white blood cell count, and high CRP at admission. Delayed hospital admission and specific clinical signs indicate poor outcomes for pediatric meningitis patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Purulent meningitis poses a significant threat to children, especially in developing countries.
- Identifying prognostic factors is crucial for timely intervention and improved outcomes in pediatric meningitis cases.
Purpose of the Study:
- To prospectively examine clinical and laboratory findings to determine prognostic factors in childhood purulent meningitis.
- To identify predictors of neurological sequelae and fatality in a developing country context.
Main Methods:
- Prospective study of 48 children with purulent meningitis.
- Evaluation of clinical variables, laboratory counts (leukocytes, thrombocytes), inflammatory markers (CRP, ESR), and cerebrospinal fluid (CSF) analysis.
- Patients categorized into surviving without sequelae, surviving with sequelae, and deceased groups.
Main Results:
- Absence of anemia, low CSF white blood cell (WBC) count (<1,000), and high C-reactive protein (CRP) at admission indicated poor prognosis.
- Later indicators of poor prognosis included fever, depressed consciousness, high CSF WBC count (>1,000), and low CRP 36-48 hours post-admission.
- Mortality was lower with penicillin G + chloramphenicol compared to ampicillin-sulbactam + cefotaxime; delayed admission correlated with worse outcomes.
Conclusions:
- Anemia, CSF WBC count, and CRP levels at admission are critical early prognostic indicators for childhood purulent meningitis.
- Clinical status and inflammatory markers assessed 36-48 hours post-admission provide further prognostic information.
- Antibiotic choice and prompt hospital admission significantly influence outcomes in pediatric meningitis.
Abstract:
In this study the clinical and laboratory findings of 48 children with purulent meningitis were examined, prospectively, to determine the prognostic factors in childhood meningitis in a developing country. Patients were examined for the following variables: history of antibiotic use; period between onset of symptoms and hospital admission; age at presentation; sex; fever; convulsion; level of consciousness; malnutrition; anemia; leukocyte and thrombocyte counts; erythrocyte sedimentation rate; serum C-reactive protein (CRP) level; and cerebrospinal fluid (CSF) including white blood cell count; glucose, protein, and CRP concentrations; antibiotic treatment; neurological sequelae; and fatality rate during the hospital stay. Most of these parameters were re-evaluated in all patients 36-48 h after admission. Patients were divided into 3 groups: surviving without sequelae, surviving with sequelae, and not surviving (deceased). A total of 48 children, 19 girls (39.5%) and 29 boys (60.5%), aged 2 months to 13 years, were included in the study. Of the 48 patients, 29 (60.5 %) survived without sequelae, 13 (27%) survived with sequelae and 6 (12.5%) died. In a comparison among groups, we found that absence of anemia, low (< 1,000) CSF white blood cell (WBC) count, and high CRP level at admission were the indicative of poor prognosis. Thirty-six to 48 h after admission, the presence of fever, depressed level of consciousness, high (> 1,000) CSF WBC count, and low CRP level were also poor prognostic factors. In addition, we observed that mortality rate was lower in the penicillin G + chloramphenicol group than in the ampicillin-sulbactam + cefotaxime group (P < 0.05). The mean period between onset of symptoms and hospital admission was longer in the surviving with sequelae and in the not surviving groups than in the surviving without sequelae group (P < 0.05).