Gram negative bacillary meningitis in infants and children in developing countries

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.