[Clinical analysis of purulent meningitis in 317 children]
1Department of Internal Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400016, China. joylm99@126.com.
Insights
Purulent meningitis (PM) predominantly affects infants, often following respiratory infections. Young age and high cerebrospinal fluid protein increase complication risks, necessitating prompt diagnosis and treatment, including subdural puncture for effusions.
Area of Science:
- Pediatric Infectious Diseases
- Neurology
- Critical Care Medicine
Context:
- Purulent meningitis (PM) is a serious infection in children, particularly infants.
- Understanding clinical features, treatment efficacy, and prognostic factors is crucial for improving outcomes.
- Identifying risk factors for complications like subdural effusion and delayed cerebral vasculitis is essential.
Purpose:
- To analyze the clinical characteristics, therapeutic strategies, and prognosis of purulent meningitis in pediatric patients.
- To identify risk factors associated with complications and sequelae in children with PM.
- To evaluate the role of subdural puncture in diagnosis and treatment of subdural effusion.
Summary:
- A retrospective study of 317 children (1 month-15 years) with PM revealed infants as the most affected group (62.6%), often with preceding respiratory infections (53.9%).
- Key manifestations included fever, convulsions (93.6% in infants), and intracranial hypertension. Subdural effusion was the most common complication (29.9%), with subdural puncture showing therapeutic benefits.
- Third-generation cephalosporins were primary treatment; vancomycin or carbapenems served as alternatives. Delayed cerebral vasculitis occurred in 14.4% of patients within 3 months post-discharge.
Impact:
- Younger age and elevated cerebrospinal fluid protein (≥1 g/L) are identified as significant risk factors for complications and sequelae.
- Subdural puncture is confirmed as both a diagnostic and therapeutic intervention for subdural effusion.
- The findings underscore the importance of follow-up visits within 3 months post-discharge to monitor for delayed cerebral vasculitis.
Objective:
To study the clinical features, treatment, and prognosis of purulent meningitis (PM) in children.
Methods:
A retrospective analysis was performed on the clinical data of 317 children with PM aged from 1 month to 15 years.
Results:
PM was commonly seen in infants (198 cases, 62.6%). Most children with PM had preceding respiratory infection (171 cases, 53.9%). The major clinical manifestations of PM were fever, convulsions, and intracranial hypertension, and convulsions were more commonly seen in infants (152 cases, 93.6%). The major complication was subdural effusion (95 cases, 29.9%). Of the 95 cases of subdural effusion, 22 cases were diagnosed by subdural puncture; 68 cases underwent subdural puncture and 62 cases restored to normal temperature 3-5 days after puncture. Risk factors associated with complications and sequelae were young age and protein≥1 g/L in cerebrospinal fluid (CSF) (OR=0.518, 1.524 respectively; P<0.05). The third-generation cephalosporins were the first choice for PM, and vancomycin or carbapenems were replacement therapy. Thirteen (14.4%) out of 90 children had delayed cerebral vasculitis during a follow-up visit within 3 months after discharge.
Conclusions:
PM is more commonly seen in infants, and the infants have a high incidence of convulsions. Young age and protein≥1 g/L in CSF may increase the risk of complications and sequelae. Subdural puncture is not only a diagnostic method but also a therapy for subdural effusion. Some children have delayed cerebral vasculitis during a follow-up visit within 3 months after discharge, so follow-up visits should be performed within 3 months after discharge.
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