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Prolonged and secondary fever in childhood bacterial meningitis
A S Daoud1, M Zaki, Q A al-Saleh
1Department of Paediatrics, Farwania Hospital, Khaldiya, Kuwait.
Abstract:
In order to study the causes of prolonged and secondary fever in bacterial meningitis, a group of 102 infants and children with proven bacterial meningitis were studied. The causative agent was Haemophilus influenzae in 58% of patients, Streptococcus pneumoniae in 25% and Neisseria meningitidis in 17%. Prolonged fever was observed in 12% of the patients. The established causes include, in order of frequency, subdural effusion, drug fever, otitis media, gastroenteritis and urinary tract infection. Secondary fever was noted in 18% of the patients. The causes, in order of frequency, were urinary tract infection, subdural effusion, otitis media, phlebitis, pneumonia and drug fever. Neither relapse of the meningitis nor inadequate response to antibiotic therapy was the cause for prolonged or secondary fever. Neurological sequalae were observed in 21 patients. There was no correlation between prolonged or secondary fever and neurological sequalae. We conclude that prolonged and secondary fever in patients with treated bacterial meningitis is rarely caused by the primary infection.
Insights
Prolonged or secondary fever in children with bacterial meningitis is rarely due to the primary infection. Common causes include complications like subdural effusion or secondary infections, not a relapse of meningitis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Bacterial meningitis can lead to prolonged or secondary fever, complicating patient management.
- Identifying the causes of persistent fever is crucial for effective treatment and improved outcomes in pediatric patients.
Purpose of the Study:
- To investigate the specific causes of prolonged and secondary fever in infants and children diagnosed with bacterial meningitis.
- To differentiate between fever caused by the primary meningitis infection and other concurrent conditions.
Main Methods:
- A cohort of 102 infants and children with confirmed bacterial meningitis was prospectively studied.
- Causative agents (Haemophilus influenzae, Streptococcus pneumoniae, Neisseria meningitidis) were identified.
- Detailed clinical evaluation was performed to identify causes of prolonged (>12%) and secondary (18%) fever.
Main Results:
- Haemophilus influenzae was the most common pathogen (58%).
- Identified causes of prolonged fever included subdural effusion, drug fever, otitis media, gastroenteritis, and urinary tract infection.
- Secondary fever causes included urinary tract infection, subdural effusion, otitis media, phlebitis, pneumonia, and drug fever.
- Relapse or inadequate antibiotic response were not identified as causes.
- No correlation was found between prolonged/secondary fever and neurological sequelae (observed in 21 patients).
Conclusions:
- Prolonged and secondary fever in treated bacterial meningitis is infrequently caused by the primary infection itself.
- Complications and co-existing infections are the primary drivers of persistent or recurrent fever in these patients.
- This finding emphasizes the need to investigate for secondary causes rather than assuming treatment failure of the initial meningitis.