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[Meningitis in pediatrics. Clinical and epidemiological study of 173 cases]
Insights
Pediatric meningitis incidence was 60/100,000. Gram stain effectively detects bacterial meningitis, though antibiotic resistance in meningococcus is increasing without current clinical failures.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Pediatric meningitis presents diagnostic challenges.
- Understanding incidence, clinical features, and antibiotic resistance is crucial.
Purpose of the Study:
- To determine the incidence of pediatric meningitis.
- To describe clinical presentation and differential diagnosis.
- To assess antibiotic resistance patterns.
Main Methods:
- Prospective follow-up of 173 meningitis cases (69 bacterial, 104 viral) in 1988.
- Utilized established clinical and laboratory protocols.
- Evaluated diagnostic test sensitivities and specificities.
Main Results:
- Meningitis attack rate: 60/100,000 children (<15 years).
- Mortality: 1.4%. Gram stain sensitivity: 61.7%. Boyer's score: 95% sensitive, 98% specific for bacterial vs. viral.
- Antibiotic resistance noted in Haemophilus and decreased penicillin susceptibility in meningococcus.
Conclusions:
- Early laboratory parameters may not reliably distinguish bacterial from viral meningitis.
- Gram stain is a sensitive method for bacterial detection in cerebrospinal fluid (CSF).
- Increased penicillin resistance in meningococcus is frequent but has not yet led to clinical failures.
Background:
To know the incidence, clinical presentation, differential diagnosis and resistance level to antibiotics in pediatric meningitis.
Methods:
173 cases of meningitis (bacterial: 69, viral: 104) have been prospectively followed during 1988 according to a previously established clinical and laboratory protocol.
Results:
Meningitis attack rate was 60 cases/100,000 children younger than 15 years per year (meningococcal: 25/100,000, Haemophilus: 2/100,000). Mortality was 1.4%. 40% of bacterial meningitis received previous antibiotic treatment. Sensitivity of culture, Gram stain, and direct antigen detection by latex and EIA was 79%, 61.7%, 20.5% and 34%, respectively. Bacterial and viral differential diagnosis, by the application of Boyer's score was 95% sensitive and 98% specific. Four out of six cases of Haemophilus meningitis were ampicillin and chloramphenicol resistant; 39% of meningococcus had their penicillin susceptibility decreased between 2 and 8 times, although no therapeutic failures were seen.
Conclusions:
Laboratory parameters might not separate bacterial and viral meningitis at early stages of illness. Gram stain is an excellent and sensitive method of bacterial detection in CSF. Moderate resistance to penicillin in meningococcus is very frequent but clinical failures are not yet present.