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Recrudescence and relapse in bacterial meningitis of childhood
Abstract:
Antibiotic therapy of bacterial meningitis in children may be complicated by reappearance of bacteria in cerebrospinal fluid during therapy (recrudescence) or within three weeks after therapy is stopped (relapse). Clinical and laboratory features of six children with recrudescence and of 21 children with relapse were reviewed. These complications occurred mainly in infants less than 2 years of age and comprised less than 1% of all cases of bacterial meningitis. Neither the initial nor the follow-up CSF findings were predictive of recrudescence or relapse. Prolonged or secondary fever was unrelated to these complications. Recrudescence was usually caused by inappropriate therapy whereas relapse after adequate therapy of bacterial meningitis was usually ascribed to persistence of infection in meningeal or parameningeal foci. Relapse did not become manifest until three or more days after discontinuation of therapy. It is concluded that routine examination of CSF at the end of adequate anti-microbial therapy is not necessary or useful when the patient has exhibited a satisfactory clinical response. Furthermore, the commonly recommended observation period of 48 hours in the hospital after discontinuation of therapy is not justified for a patient who has had an uneventful course.
Insights
Recrudescence and relapse of bacterial meningitis in children are rare complications. Routine cerebrospinal fluid (CSF) examination after adequate therapy is unnecessary for clinically well patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Bacterial meningitis in children can involve recrudescence (bacteria reappearance during therapy) or relapse (reappearance after therapy).
- These complications are infrequent, affecting less than 1% of pediatric bacterial meningitis cases, primarily in infants under two years old.
Purpose of the Study:
- To review clinical and laboratory features of recrudescence and relapse in pediatric bacterial meningitis.
- To determine the predictability of initial and follow-up cerebrospinal fluid (CSF) findings for these complications.
- To evaluate the necessity of routine CSF examination and post-therapy observation periods.
Main Methods:
- Retrospective review of clinical and laboratory data for six children with recrudescence and 21 with relapse.
- Analysis of initial and follow-up CSF findings, fever patterns, and treatment regimens.
- Correlation of findings with the occurrence of recrudescence and relapse.
Main Results:
- Neither initial nor follow-up CSF results predicted recrudescence or relapse.
- Prolonged or secondary fever was not associated with these complications.
- Recrudescence often stemmed from inadequate therapy, while relapse was linked to persistent infection in foci after adequate therapy, typically manifesting after three days post-therapy cessation.
Conclusions:
- Routine CSF examination at the end of adequate antibiotic therapy for bacterial meningitis is not indicated in clinically responsive patients.
- A 48-hour hospital observation period post-therapy is not justified for patients with an uneventful clinical course.