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Meningitis due to Staphylococcus aureus in children
1Department of Pediatrics, Bowman Gray School of Medicine, Wake Forest University, Brenner Children's Hospital, Winston-Salem, North Carolina 27157.
Abstract:
Meningitis due to Staphylococcus aureus is uncommon, occurring primarily in patients with known preexisting abnormalities of the CNS (including patients who have undergone previous neurosurgery or trauma). We reviewed our experience with meningitis due to S. aureus in children seen at two medical centers. Among the 40 patients, 32 (80%) had a known predisposing abnormality of the CNS at the time of diagnosis of S. aureus meningitis; all of these 32 patients had had recent neurosurgery, most for placement or revision of a ventriculoperitoneal shunt. Eight patients had no known predisposing CNS abnormality. Four of these eight patients were known to be immunocompromised. The other four patients all had an occult CNS abnormality demonstrated during subsequent workup. Our series demonstrates that when the diagnosis of S. aureus meningitis is made in the absence of a known predisposing CNS abnormality or immunologic defect, then a timely search for an occult CNS abnormality should be undertaken.
Insights
Staphylococcus aureus meningitis is rare, often linked to central nervous system (CNS) issues or surgery. In children without known CNS problems, a hidden CNS abnormality may be present and requires investigation.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Meningitis caused by Staphylococcus aureus is infrequent.
- It predominantly affects individuals with pre-existing central nervous system (CNS) abnormalities, such as those with a history of neurosurgery or trauma.
Observation:
- A review of 40 children with S. aureus meningitis was conducted across two medical centers.
- The majority (80%) had known CNS abnormalities, frequently related to neurosurgery for ventriculoperitoneal shunts.
- A significant minority (20%) lacked apparent predisposing CNS factors.
Findings:
- Of the eight patients without known CNS abnormalities, four were immunocompromised.
- The remaining four patients without known risk factors were found to have an occult CNS abnormality upon further investigation.
- This highlights the importance of thorough workup in seemingly uncomplicated cases.
Implications:
- The study underscores the need for a prompt and thorough search for occult CNS abnormalities in children diagnosed with S. aureus meningitis, especially when no clear predisposing factors are identified.
- Early detection of underlying CNS issues is crucial for effective management and improved patient outcomes.
- This research contributes to understanding the diverse etiologies and risk factors associated with S. aureus meningitis in pediatric populations.