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Risk Factors in Children Older Than 5 Years With Pneumococcal Meningitis: Data From a National Network
Fanny Hénaff1, Corinne Levy, Robert Cohen
1From the *Urgences pédiatriques, CHU Nantes, Hôpital Mère-Enfant, 44093 Nantes, France; †ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, 94100 Saint-Maur des Fossés, France; ‡Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; §Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; ¶Laboratoire de génétique humaine des maladies infectieuses, institut national de la santé et de la recherche médicale, UMR1163, Institut IMAGINE, 75015 Paris, France; ‖Faculté de médecine de Necker, Université Paris V René-Descartes, 75015 Paris, France; **Centre d'études des déficits immunitaires (CEDI), AP-HP, hôpital Necker-Enfants-Malades, 75015 Paris, France; ††Centre National de Référence des Pneumocoques, AP-HP, HEGP (Hôpital Européen Georges Pompidou), Université Paris V, 75006 Paris, France; and ‡‡Pédiatrie générale, CHU Nantes, Hôpital Mère-Enfant, 44093 Nantes, France.
Insights
In children over five with pneumococcal meningitis, anatomical factors like cerebrospinal fluid leaks and immunodeficiency were common predisposing risks. A third of patients had identifiable risk factors, necessitating further investigation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Meningitis in children over five can stem from anatomical issues (e.g., cerebrospinal fluid fistula) or immune system deficiencies.
- Identifying these predisposing factors is crucial for understanding and managing pneumococcal meningitis.
Purpose of the Study:
- To evaluate the prevalence and types of anatomical and immunological risk factors in children older than five diagnosed with pneumococcal meningitis.
- To analyze clinical features and prevalent pneumococcal serotypes in this age group.
Main Methods:
- A retrospective analysis of children aged 5-15 diagnosed with pneumococcal meningitis between 2001 and 2013.
- Data collection included risk factor typology, clinical presentation, and pneumococcal serotype identification.
Main Results:
- Out of 316 patients, 34% had risk factors; anatomical issues (cerebrospinal fluid breach/fistula) were most common (22.8%), followed by immunodeficiency (17.9%).
- The mortality rate was 9.5%, with 23.1% experiencing complications. Serotype 3, 19A, and 19F were frequently identified.
Conclusions:
- This study represents the largest cohort of children over five with pneumococcal meningitis.
- A significant proportion of these children possess risk factors warranting comprehensive immunologic and radiological assessment.
Background:
The occurrence of meningitis in children >5 years old may be associated with specific predisposing factors that can be anatomic, such as cerebrospinal fluid fistula or breach, or related to genetic susceptibility or N inborn or acquired immunologic defect. This study aimed to assess the anatomical and immunologic risk factors in children >5 years old with pneumococcal meningitis and prospectively enrolled in the French national meningitis network.
Methods:
We analyzed all data for children who were 5-15 years old with a diagnosis of pneumococcal meningitis between 2001 and 2013. We describe the frequency and typology of the anatomic or immunologic risk factors, the clinical features and the pneumococcal serotypes.
Results:
Among the 316 patients with pneumococcal meningitis, the mortality rate was 9.5% and 23.1% of cases presented complications (abscess, coma, hemodynamic failure, thrombophlebitis cerebral or deafness). In total, 108 children (34%) showed risk factors, the most frequent being anatomic: 70 cases (22.8%) were related to a cerebrospinal fluid breach or fistula and 55 (17.9%) to immunodeficiency, primary or acquired. Serotype data were available for 207 pneumococcal isolates (65.5%). The most frequent serotypes were as follows: 3, 18C, 19A and 19F between 2001 and 2009 and 19F, 3, 19A, 12F, 22F, 17F and 24F after 2009.
Conclusions:
We describe the largest cohort of children >5 years old with pneumococcal meningitis. One third of the children had risk factors justifying a complete immunologic and radiologic work-up.