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Gram negative bacillary meningitis in infants and children in developing countries
G O Akpede1, O Adeyemi, E O Ogiji
1Department of Paediatrics, University of Muiduguri Hospital, Nigeria.
Abstract:
Gram negative bacillary meningitis (GNBM) in postneonatal infants and children is two to three times more common in developed compared to developing countries. Other major differences are in the pattern of pathogens (mainly Klebsiella spp and Salmonella spp in developing versus E. coli in developed countries) and associated conditions (diarrhoeal diseases and malnutrition in developing versus neurosurgical and urinary tract abnormalities in developed countries). 12 (11.5%) of 104 cases of bacterial meningitis were due to GNB, including Klebsiella spp seven, E. coli, two and untyped Coliform spp, three; the age range of patients with GNBM was 3-24 months. Among seven completely evaluable patients, six presented after seven days of illness, five convulsed on or before admission, and six had accompanying respiratory or gastro-enteritic illnesses but none was severely malnourished or had associated neurosurgical or urinary tract abnormalities. Three patients died, three were discharged with sequelae and one without sequelae. The only significant difference between patients with GNBM and those with meningitis due to "usual" pathogens was the greater tendency to delayed presentation among the former (6/7 patients with GNBM versus 11/36 "usual" pathogens; p = 0.011); this was also the only striking difference in presentation when compared with patients from developed countries. The need for further studies, preferably multicentred, and for a revision of the traditional combination of gentamicin and ampicillin or chloramphenicol and ampicillin for the treatment of GNBM in developing countries is discussed.
Insights
Gram-negative bacillary meningitis (GNBM) is more common in developed nations, with different pathogens and conditions. Delayed presentation is a key difference in developing countries, necessitating treatment strategy revisions.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Gram-negative bacillary meningitis (GNBM) presents differently in developed versus developing countries regarding pathogens and associated conditions.
- While more common in developed nations, GNBM requires specific attention in developing regions due to distinct epidemiological patterns.
Purpose of the Study:
- To analyze the characteristics and outcomes of Gram-negative bacillary meningitis in postneonatal infants and children in a developing country context.
- To compare the presentation and associated factors of GNBM with meningitis caused by other pathogens and with GNBM cases in developed countries.
Main Methods:
- Retrospective analysis of 104 bacterial meningitis cases, identifying 12 (11.5%) caused by Gram-negative bacilli (GNB).
- Detailed evaluation of seven fully assessable GNBM cases, focusing on clinical presentation, illness duration, comorbidities, and treatment outcomes.
- Statistical comparison of GNBM patient presentation with those having meningitis from "usual" pathogens and with reported data from developed countries.
Main Results:
- In this cohort, GNBM was caused by Klebsiella spp., E. coli, and Coliform spp. in patients aged 3-24 months.
- GNBM cases showed a significant tendency for delayed presentation (over 7 days) compared to other bacterial meningitis cases (6/7 vs. 11/36, p=0.011).
- Outcomes included mortality (3/7), sequelae (3/7), and recovery without sequelae (1/7), with no severe malnutrition or specific abnormalities noted.
Conclusions:
- Delayed presentation is a critical distinguishing factor for GNBM in developing countries.
- Current treatment regimens (e.g., gentamicin/ampicillin) may require revision for GNBM in developing regions.
- Further multicenter studies are essential to guide optimal management strategies for GNBM in diverse settings.