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Pneumococcal meningitis in children
Insights
Pneumococcal meningitis in children often leads to severe outcomes and neurological issues, particularly in infants. While mortality has decreased, prompt diagnosis and treatment remain critical for improving prognosis in pediatric cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Pneumococcal meningitis is a serious infection in children.
- Understanding its clinical and laboratory features is crucial for prognosis.
Purpose of the Study:
- To review the clinical and laboratory features of pneumococcal meningitis in children.
- To analyze factors associated with mortality and neurological sequelae.
Main Methods:
- Retrospective review of 79 children with 83 episodes of pneumococcal meningitis over 26 years.
- Analysis of clinical presentation, laboratory findings, treatment, and outcomes.
Main Results:
- 31% of patients experienced convulsions; mortality was 10.8%, primarily in infants under 1 year.
- Poor prognostic indicators included pneumonia, hypoglycorrhachia, and elevated CSF protein.
- 56% of patients had neurological sequelae, such as deafness and hydrocephalus.
Conclusions:
- Pneumococcal meningitis in children, despite reduced mortality, is frequently associated with severe outcomes.
- Early identification of poor prognostic factors is essential for managing pediatric pneumococcal meningitis.
Abstract:
We review the clinical and laboratory features of 79 children with 83 episodes of pneumococcal meningitis over a 26-year period. The onset of illness was often severe, with convulsions occurring in 31% of the patients. The mortality was 10.8% and all deaths occurred in patients younger than 1 year of age; the death rate has dropped from 19% in the 1948 to 1962 era to 3% from 1963 to 1973. The association of pneumonia with meningitis, the presence of hypoglycorrhachia, and an increased CSF protein concentration were associated with a poor prognosis; bacteremia and convulsions were also more common in the fetal cases. Neurologic sequelae including recurrent meningitis, deafness, hydrocephalus, convulsions, and retardation were present in 56% of the patients observed. Findings from EEGs did not correlate well with the clinical picture during the acute or convalescent stage of the illness. Despite accurate diagnosis, prompt therapy, and a decrease in the mortality in the past decade, pneumococcal meningitis in children is still often associated with a serious outcome.