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[Salmonella meningitis in children in Libreville. Retrospective study of 9 cases]
1Service de pédiatrie générale, hôpital pédiatrique d'Owendo, Libreville, Gabon.
Background:
Salmonella meningitis is a rare entity, even in tropical area where salmonellosis is common. Its prognosis is poor and the choice of adequate antibiotic therapy is difficult.
Patients And Methods:
The files of nine children (three boys, six girls) admitted to the pediatric unit of the Owendo Pediatric Hospital in Libreville for salmonella meningitis between January 1, 1989, and December 31, 1993 were retrospectively studied. Diagnosis was established by a positive culture of cerebrospinal fluid.
Results:
Salmonella was the third cause (8.65%) of purulent meningitis observed during this period. Eight children were less than 1-year old, seven were from low socioeconomic standard families. The main clinical manifestations were fever (seven cases), pallor (six cases), diarrhea (four cases), nuchal rigidity (four cases), convulsions (three cases) and bulging fontanel (three cases). Five children (55.5%) were severely anemic (hemoglobin < 5 g/dL) but none had abnormal hemoglobin. Serotyping could not be performed in any case. Salmonella isolates were resistant to chloramphenicol in six cases and to ampicillin in five. Cefotaxime (200 mg/kg/24 h intravenously in three divided doses) was given to seven patients. The duration of therapy was at least 3 weeks in four patients. There were five deaths at ages ranging from 1 to 12 months, ie, a case fatality rate of 55.5%. Three patients (33.3%) recovered with neurological sequels.
Conclusion:
The prognosis of salmonella meningitis is poor, even in the case of prompt diagnosis and adequate therapy. Preventive measures only can decrease the risk of illness in children.
Insights
Salmonella meningitis in children has a poor prognosis, with a high fatality rate of 55.5% and significant neurological sequelae. Preventive measures are crucial for reducing illness risk.
Area of Science:
- Pediatric Infectious Diseases
- Bacterial Meningitis Pathogenesis
- Antimicrobial Resistance
Context:
- Salmonella meningitis is a rare but severe infection, particularly in tropical regions where salmonellosis is endemic.
- This retrospective study analyzed nine cases of Salmonella meningitis in children admitted to Owendo Pediatric Hospital between 1989 and 1993.
- The study highlights the challenges in diagnosing and treating this condition, especially in resource-limited settings.
Purpose:
- To investigate the clinical characteristics, treatment outcomes, and prognosis of Salmonella meningitis in pediatric patients.
- To assess the prevalence of Salmonella as a cause of meningitis in the studied population.
- To evaluate the antibiotic resistance patterns of Salmonella isolates and the efficacy of therapeutic interventions.
Summary:
- Salmonella was the third leading cause of purulent meningitis (8.65%), predominantly affecting infants under one year old from low socioeconomic backgrounds.
- Clinical presentations included fever, pallor, diarrhea, and neurological signs; severe anemia was noted in over half of the cases.
- High rates of resistance to chloramphenicol (6/9) and ampicillin (5/9) were observed, with a case fatality rate of 55.5% and neurological sequelae in 33.3% of survivors.
Impact:
- The findings underscore the critical need for effective preventive strategies against Salmonella infections in children.
- This study emphasizes the poor prognosis associated with Salmonella meningitis, even with timely diagnosis and treatment.
- The observed antimicrobial resistance highlights the importance of surveillance and the potential need for alternative therapeutic agents.