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Clinical data in children with meningococcal meningitis in a Spanish hospital
C Luaces Cubells1, J J García García, J Roca Martínez
1Department of Paediatrics, Unitat Integrada Hospital Clinic-Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
Abstract:
Neisseria meningitidis is the main cause of bacterial meningitis in Spain. Of the 213 children included in this study with meningococcal meningitis, 7 died. Mortality was linked to a shorter time from the first symptom to diagnosis (mean time for fatal cases was 9.5 h, mean time for survivors was 19 h, p = 0.034), to deteriorated consciousness (DC) (mortality rate (MR) with DC = 6/87, MR without DC = 1/124, p = 0.02) and to shock (MR with shock = 5/7, MR without shock = 2/206, p < 0.0001). Previous treatment reduced the yield from blood culture (36/54 versus 45/137, p < 0.0001). Positivity in both Gram stain (GS) and cerebrospinal fluid (CSF) culture increased with longer duration of symptoms (mean GS+ = 25 h, GS- = 16 h, p = 0.004; CSF+ = 20 h, CSF- = 12 h, p = 0.001), and blood culture (BC) gave more positive results when carried out earlier (mean BC- = 14 h, BC- = 24 h, p < 0.001). Reduced susceptibility to penicillin was seen in 34% of the strains, and rapidly evolving forms were responsible for most of the deaths; reduced susceptibility was more frequent among strains responsible for death or sequelae (9/15 = 60%) as compared with the more harmless strains (69/ 215 = 32%) (p = 0.04). The progressive reduction of susceptibility to penicillin indicates that it should be replaced by a third-generation cephalosporine.
Insights
Rapid diagnosis and prompt recognition of shock are crucial for improving survival rates in pediatric meningococcal meningitis. Penicillin resistance is increasing, necessitating a shift to third-generation cephalosporins for effective treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Neisseria meningitidis is a primary cause of bacterial meningitis in children in Spain.
- Meningococcal meningitis presents a significant public health challenge with a notable mortality rate.
Purpose of the Study:
- To identify key factors influencing mortality in pediatric meningococcal meningitis.
- To evaluate the diagnostic yield of microbiological tests based on symptom duration and prior treatment.
- To assess the prevalence of antimicrobial resistance and its correlation with disease severity.
Main Methods:
- Retrospective analysis of 213 pediatric cases of meningococcal meningitis.
- Correlation of clinical parameters (time to diagnosis, consciousness level, shock) with outcomes.
- Evaluation of microbiological diagnostic methods (Gram stain, CSF culture, blood culture) based on timing and prior antibiotic use.
- Antimicrobial susceptibility testing for Neisseria meningitidis strains, focusing on penicillin resistance.
Main Results:
- Mortality was significantly associated with shorter time to diagnosis (9.5h vs 19h), deteriorated consciousness, and shock.
- Previous antibiotic treatment reduced the positivity rate of blood cultures.
- Diagnostic test positivity (Gram stain, CSF culture) increased with longer symptom duration, while blood cultures were more positive when collected earlier.
- Reduced penicillin susceptibility was observed in 34% of strains, significantly higher in severe cases (60% vs 32%).
Conclusions:
- Timely diagnosis and management of shock are critical for reducing mortality in pediatric meningococcal meningitis.
- Antimicrobial resistance to penicillin is a growing concern, with higher rates in severe infections.
- Third-generation cephalosporins are recommended as a replacement for penicillin due to increasing resistance.