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Bacterial meningitis in older children
W A Bonadio1, M Mannenbach, R Krippendorf
1Department of Pediatrics, Medical College of Wisconsin, Children's Hospital, Milwaukee.
Abstract:
A review was performed of 25 cases of bacterial meningitis in previously healthy children aged 6 years or older during a 10-year period. The rate of infection in this age group relative to all cases of pediatric bacterial meningitis was 4%. Pathogens included Haemophilus influenzae type b in 10 cases (40%), Neisseria meningitidis in 9 cases (36%), and Streptococcus pneumoniae in 6 cases (24%). Physical findings revealed 21 patients (84%) with some degree of altered consciousness and 25 patients (100%) with nuchal rigidity. In all instances, the cerebrospinal fluid exhibited pleocytosis with a predominance of polymorphonuclear leukocytes. Eleven patients (44%) were afebrile on presentation. Of 22 surviving patients, 10 (45%) were afebrile without subsequent fever after administration of the initial dose of antibiotics, in 5 (23%) fever resolved within 24 hours, and in 6 (27%) fever resolved within 48 hours of treatment; there was no instance of prolonged or secondary fever noted. Death occurred in 3 cases (12%). Bacterial meningitis is uncommon in older children. As compared with younger children, older children with bacterial meningitis commonly present without fever and tend to have their fever resolve shortly after effective antibiotic therapy is initiated without manifesting prolonged or secondary fever patterns. Haemophilus influenzae type b is a common cause of bacterial meningitis in children aged 6 years or older; empirical antibiotic therapy in this clinical situation should include treatment of this pathogen.
Insights
Bacterial meningitis is rare in children over 6, often presenting without fever. Older children typically show rapid fever resolution post-antibiotics, with Haemophilus influenzae type b being a common pathogen.
Area of Science:
- Pediatric Infectious Diseases
- Neurology
- Microbiology
Background:
- Bacterial meningitis is a serious infection affecting the membranes surrounding the brain and spinal cord.
- While common in younger children, its occurrence and presentation in older children (≥6 years) are less understood.
- This study reviews cases in a specific age group to clarify epidemiology and clinical features.
Purpose of the Study:
- To analyze the characteristics of bacterial meningitis in previously healthy children aged 6 years and older.
- To identify common pathogens and clinical presentations in this age group.
- To compare the clinical course and fever patterns with those typically seen in younger children.
Main Methods:
- Retrospective review of 25 cases of bacterial meningitis in children aged 6 years or older over a 10-year period.
- Analysis of patient demographics, causative pathogens, clinical findings, cerebrospinal fluid (CSF) analysis, and treatment outcomes.
- Comparison of fever patterns before and after antibiotic administration.
Main Results:
- Bacterial meningitis accounted for 4% of pediatric cases in this age group.
- Haemophilus influenzae type b (40%), Neisseria meningitidis (36%), and Streptococcus pneumoniae (24%) were the primary pathogens.
- Altered consciousness (84%) and nuchal rigidity (100%) were common findings; 44% were afebrile on presentation.
- Fever resolved rapidly within 48 hours in most surviving patients after antibiotic initiation, with no prolonged or secondary fever.
- Mortality rate was 12%.
Conclusions:
- Bacterial meningitis is infrequent but significant in older children.
- Older children often present without fever and experience prompt fever resolution with antibiotics.
- Empirical antibiotic therapy should target Haemophilus influenzae type b in this population.