Bacterial meningitis in children at Kalafong Hospital, 1990-1995

To determine the bacteriological profile, morbidity, mortality and factors which contributed to the outcome.

Retrospective descriptive.

Kalafong Hospital, Pretoria.

Children older than 1 month and younger than 13 years admitted between January 1990 and December 1995 with culture-proven bacterial meningitis.

Causative bacteria, antibiotic sensitivity, age, clinical features and short-term morbidity and mortality.

Sixty-one patients had culture-proven bacterial meningitis. In 57% Haemophilus influenzae, in 33% Streptococcus pneumoniae and in 1.6% (1 patient) Neisseria meningitidis were cultured (5 patients yielded other organisms). Some H. influenzae cultures showed resistance to cefotaxime and ampicillin and some S. pneumoniae cultures to penicillin. The mean age of all patients was 18 months. Twenty-three per cent of the patients had consulted between 1 and 5 health workers and were then self-referred. Fever, cough and vomiting were the most common complaints. On examination, fever and pneumonia were the most common findings apart from neurological system involvement. Twelve patients (20%) died and 46% were discharged with obvious neurological complications. Morbidity and mortality were the highest for S. pneumoniae meningitis. Bad prognostic features were delayed referral, S. pneumoniae meningitis, convulsions and abnormal neurological signs on admission.

H. influenzae was the most common cause of childhood bacterial meningitis at Kalafong Hospital, with N. meningitidis meningitis being very rare. Morbidity and mortality were very high, compared with outcome in developed countries. Delayed referral seems to be an important factor in predicting an adverse outcome.