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Gram-negative enteric bacillary meningitis: a twenty-one-year experience
M Unhanand1, M M Mustafa, G H McCracken
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas.
The Journal of Pediatrics
|January 1, 1993
Summary
Gram-negative enteric bacillary meningitis in infants is serious, with high fatality and long-term issues. Early diagnosis and treatment are crucial for better outcomes in affected neonates and infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Gram-negative enteric bacillary meningitis (GN-EBM) poses a significant threat to neonates and infants.
- Predisposing factors like neural tube defects and urinary tract anomalies are present in a notable percentage of cases.
Purpose of the Study:
- To review the clinical experience with GN-EBM in a pediatric population over a 20-year period.
- To identify causative agents, clinical features, diagnostic findings, treatment outcomes, and long-term sequelae.
Main Methods:
- Retrospective review of 98 neonates and infants diagnosed with GN-EBM between 1969 and 1989.
- Analysis of patient demographics, predisposing factors, causative organisms, cerebrospinal fluid (CSF) and blood culture results, CSF analysis, and treatment regimens.
Main Results:
- Escherichia coli was the most common pathogen (53%).
- Gram-negative bacilli were seen on CSF smears in 61% of patients; blood cultures were positive in 55%.
- The case-fatality rate was 17%, with 61% of survivors experiencing long-term sequelae.
Conclusions:
- GN-EBM in infants has a high mortality and morbidity rate.
- Effective antimicrobial therapy is essential, with an average of 3 days for CSF sterilization.
- Long-term neurodevelopmental and physical disabilities are common among survivors.