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Published on: November 5, 2019
Otogenic meningitis in children
Laura Lempinen1,2, Riste Saat3,4, Anu Laulajainen-Hongisto5
1Department of Radiology, HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, PB 340, Helsinki, 00029 HUS, Finland. laura.j.lempinen@hus.fi.
Purpose:
Otogenic meningitis is a rare but potentially life-threatening intracranial complication of otitis media (OM). Our aim was to study the incidence of childhood otogenic meningitis and to compare clinical presentation, causative pathogens, diagnostics, treatment, and outcome of otogenic versus non-otogenic meningitis.
Methods:
Charts were reviewed for 47 children admitted to our tertiary center with bacterial meningitis (BM) between 2010 and 2020. Otoscopy and/or imaging were used to determine the otogenic meningitis ratio and the mean annual incidence was calculated.
Results:
Eight (17%) of the 47 BM cases were otogenic [5 males; median age 1.3 years (range 2 months to 16 years)]. The otogenic meningitis incidence was 0.3/100 000/year. The classic triad of fever, altered level of consciousness, and meningeal irritation was more common in children with otogenic meningitis (50%, 4/8) than without OM (14%, 5/36) (P = 0.042). Streptococcus pneumoniae was a more common pathogen in children with OM (88%, 7/8) than without OM (14%, 4/29) (P < 0.001), whereas Neisseria meningitidis infection occurred only in children without OM (41%, 12/29) (P = 0.036). Neurological sequelae at discharge were present in 3 (38%) children with OM. Deafness was diagnosed in two children, both with otogenic backgrounds. Three children showed long-term sequelae: 2 had deafness (aged < 2 years) and 1 had aphasia/dysphasia.
Conclusion:
The incidence of otogenic meningitis was 0.3/100 000/year, with S. pneumoniae the most common causative pathogen. Deafness was the most common long-term sequela and occurred only in children with otogenic meningitis.
Insights
Otogenic meningitis, a complication of otitis media (middle ear infection), affects children rarely. Streptococcus pneumoniae is the most common cause, and deafness is the most frequent long-term complication.
Area of Science:
- Pediatrics
- Infectious Diseases
- Otolaryngology
Background:
- Otogenic meningitis is a rare but severe intracranial complication of otitis media (OM).
- Understanding its incidence and characteristics is crucial for timely diagnosis and management.
Purpose of the Study:
- To determine the incidence of childhood otogenic meningitis.
- To compare clinical presentation, pathogens, diagnostics, treatment, and outcomes of otogenic versus non-otogenic meningitis.
Main Methods:
- Retrospective chart review of 47 children with bacterial meningitis (BM) between 2010-2020.
- Otoscopy and/or imaging used to identify otogenic cases.
- Calculation of mean annual incidence.
Main Results:
- Eight (17%) of 47 BM cases were otogenic, with an incidence of 0.3/100,000/year.
- The classic triad of meningitis symptoms was more frequent in otogenic cases (50% vs. 14%).
- Streptococcus pneumoniae was the predominant pathogen in otogenic meningitis (88%), while Neisseria meningitidis was found in non-otogenic cases.
- Deafness was the most common long-term sequela (38%), occurring exclusively in children with otogenic meningitis.
Conclusions:
- The incidence of childhood otogenic meningitis is low (0.3/100,000/year).
- Streptococcus pneumoniae is the primary causative agent.
- Deafness is the most significant long-term sequela and is specific to otogenic meningitis.
