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Unusual Gram-negative bacteria cause more severe bacterial meningitis than the three classical agents in children

Heikki Peltola1, Irmeli Roine2, Markku Kallio1

  • 1Pediatrics, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.

Acta Paediatrica (Oslo, Norway : 1992)
|April 13, 2022
PubMed
Abstract

Insights

Childhood bacterial meningitis (BM) from nonclassical bacteria, particularly Gram-negative, is more severe and increases mortality risk. As classical BM agents decline due to vaccines, nonclassical causes are becoming more prevalent.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Epidemiology

Background:

  • Childhood bacterial meningitis (BM) poses a significant health challenge globally.
  • Classical bacterial agents (Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae) have historically dominated BM cases.
  • The evolving landscape of bacterial meningitis aetiologies necessitates updated comparative analyses.

Purpose of the Study:

  • To compare the clinical characteristics, mortality, and sequelae of childhood bacterial meningitis (BM) caused by classical agents versus other bacterial aetiologies.
  • To investigate geographical variations in BM aetiology and outcomes across Finland, Latin America, and Angola.
  • To assess the impact of nonclassical bacterial agents on disease severity and patient outcomes.

Main Methods:

  • Secondary analysis of data from five prospective treatment trials on non-neonatal BM.
  • Study period: 1984-2017, encompassing cases from Finland, Latin America, and Angola.
  • Comparison of outcomes between BM caused by classical agents and other bacterial aetiologies.

Main Results:

  • Of 1568 BM cases, 93% were caused by classical agents; 7% by other Gram-negative or Gram-positive bacteria.
  • Nonclassical Gram-negative BM was significantly more prevalent in Angola.
  • Children with nonclassical BM presented later, were more underweight and anaemic, and had a twofold increased odds for death and 2.5-fold increased odds for death or severe sequelae.

Conclusions:

  • Bacterial meningitis of nonclassical aetiology represents a particularly severe disease, especially in vulnerable populations like Angolan children.
  • The diminishing role of classical BM agents due to vaccination programs is leading to a growing prevalence of nonclassical causes.
  • Nonclassical bacterial meningitis requires targeted interventions and heightened clinical suspicion, particularly in regions with limited resources.
Keywords:
Haemophilus influenzaeStreptococcus pneumoniaeGram-negative bacteriabacterial meningitischild

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