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[Clinical studies on pediatric purulent meningitis--statistical analysis of etiology and therapy]
K Fukunaga1, C Nishimura, H Tamaki
1Department of Pediatrics, Tokyo Jikei University School of Medicine.
Abstract:
In a total of 149 children with purulent meningitis we encountered in our institute in the last 20 years, the causatives, the changes in therapeutic management and the prognosis were investigated. The causatives could be detected in 109 patients (73%): H. influenzae; 30 patients (20%), S. pneumoniae; 18 patients (12%), E. coli; 13 patients (9%), GBS; 7 patients (5%) and S. aureus; 6 patients (4%). These five causatives were detected in 49% of the total patients, or 67% of the patients in whom causatives could be detected. Of these five causatives, E. coli were detected the most frequently in the first half of 1970's, but, in recent years, the detection of GBS, S. pneumoniae and H. influenzae has been remarkably increasing. In spite of progress in antibiotics, the prognosis of the disease due to S. pneumoniae, GBS and S. aureus was poor. In the majority of the patients who died, the death came within five days after hospitalization due to loss of consciousness, convulsion etc. It is therefore necessary not only to initiate strong antibiotic treatment as soon as possible after early diagnosis, but also to take symptomatic measures such as steroidal treatment, treatment of shock etc.
Insights
This study investigated purulent meningitis in children over 20 years. While bacterial causes shifted, outcomes for Streptococcus pneumoniae, GBS, and Staphylococcus aureus remained poor, necessitating prompt treatment and supportive care.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Context:
- Purulent meningitis remains a significant pediatric concern.
- Longitudinal analysis of causative agents and treatment outcomes is crucial for evolving clinical practice.
Purpose:
- To investigate the causative agents, therapeutic management changes, and prognosis of purulent meningitis in children over a 20-year period.
- To identify trends in bacterial pathogens and assess their impact on patient outcomes.
Summary:
- A 20-year retrospective study of 149 children with purulent meningitis identified key causative agents: Haemophilus influenzae, Streptococcus pneumoniae, Escherichia coli, Group B Streptococcus (GBS), and Staphylococcus aureus.
- While E. coli was prevalent earlier, recent years show an increase in GBS, S. pneumoniae, and H. influenzae.
- Despite advances in antibiotics, prognosis for meningitis caused by S. pneumoniae, GBS, and S. aureus was poor, with most deaths occurring within five days of hospitalization.
Impact:
- Highlights the dynamic nature of bacterial meningitis pathogens in children.
- Emphasizes the need for early diagnosis and aggressive treatment, including antibiotics and supportive measures like steroids and shock management.
- Informs clinical guidelines for managing pediatric purulent meningitis, stressing timely intervention for improved survival rates.