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[Factors associated with the prognosis of bacterial meningitis in children]
M Takayanagi1, K Yamamoto, H Nakagawa
1Department of Pediatrics, Tohoku University School of Medicine, Sendai.
Abstract:
Treatment of bacterial meningitis depends on its severity. The signs, symptoms, and laboratory values of 51 patients with bacterial meningitis admitting to the Department of Pediatrics at Sendai City Hospital from January 1985 to December 1994 were analyzed in order to evaluate their prognostic value. The overall mortality rate was 3.9%. The incidence of neurological deficit on discharge was 31.4%. According to their prognoses, patients were divided into two groups: those who recovered with no detectable disabilities (good prognosis) and those who died or were left with neurological deficits (poor prognosis). An analysis of these groups using Fisher's exact probability test revealed that the following risk factors were associated with poor prognosis: 1) duration of fever (including the periods of relapse) for more than 10 days ; 2) abnormal findings on brain imaging, such as cerebral infarction, cerebral hemorrhage, cerebral abscess and subdural effusion: 3 initial serum CRP value above 16 mg/dl; 4) initial CSF glucose value below 12 mg/dl; and 5) initial CSF LDH value above 220 IU/l. Streptococcus pneumoniae infection carried the worst prognosis: the causal organism of both the two fetal cases was S. pneumoniae. The incidence of poor prognosis was also high in S. pneumoniae meningitis (60.0%), compared to those by Hemophilus influenzae (46.7%) and group B streptococcus (25.0%). In the cases in which causal agents were not detected, this incidence was as low as 10 percent, showing significant difference from cases in which causal agents were identified. In order to improve the prognosis of bacterial meningitis, factors associated with poor prognosis should be recognized at early stages of the illness.
Insights
Early recognition of bacterial meningitis risk factors like prolonged fever and abnormal brain imaging is crucial for improving patient outcomes. Streptococcus pneumoniae infections indicate a poorer prognosis, highlighting the need for timely intervention.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Context:
- Bacterial meningitis poses a significant threat, with treatment efficacy dependent on disease severity.
- Assessing prognostic indicators in pediatric bacterial meningitis is vital for clinical management.
- A retrospective analysis of 51 pediatric patients was conducted at Sendai City Hospital.
Purpose:
- To evaluate the prognostic value of clinical signs, symptoms, and laboratory findings in pediatric bacterial meningitis.
- To identify key risk factors associated with poor prognosis in bacterial meningitis cases.
- To compare prognosis across different causative agents, including Streptococcus pneumoniae.
Summary:
- Prolonged fever (>10 days), abnormal brain imaging (infarction, hemorrhage, abscess, effusion), elevated serum C-reactive protein (>16 mg/dL), low cerebrospinal fluid glucose (<12 mg/dL), and high cerebrospinal fluid lactate dehydrogenase (>220 IU/L) were linked to poor outcomes.
- Streptococcus pneumoniae infections demonstrated the worst prognosis, with a 60% incidence of poor outcomes.
- Cases with unidentified causal agents had a significantly lower incidence of poor prognosis (10%) compared to those with identified agents.
Impact:
- Identified critical risk factors for poor prognosis in pediatric bacterial meningitis.
- Highlights the severe implications of Streptococcus pneumoniae meningitis.
- Emphasizes the importance of early recognition of risk factors for improved treatment strategies and patient outcomes.