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[Multicenter prospective study on severe bacterial meningitis in children]
J Casado Flores1, M A García Teresa, F Cambra
1Grupo Colaborativo para el Estudio de las Infecciones del SNC en UCI Pediátrica, Hospital Infantil Niño Jesús, Madrid.
Insights
Bacterial meningitis in children is influenced by age, with Haemophilus influenzae type b and Neisseria meningitidis common in infants. Streptococcus pneumoniae showed the highest mortality rate.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Intensive Care Medicine
Context:
- Bacterial meningitis remains a significant cause of pediatric morbidity and mortality.
- Understanding the epidemiology and clinical presentation is crucial for timely intervention.
Purpose:
- To prospectively study the epidemiology, clinical signs, and outcomes of bacterial meningitis in children admitted to a Pediatric Intensive Care Unit (PICU).
Summary:
- A study of 125 children in Spanish PICUs (1994-1995) found Neisseria meningitidis, Haemophilus influenzae type b, and Streptococcus pneumoniae as primary pathogens.
- Age significantly impacts etiological agents, with H. influenzae type b and N. meningitidis having similar incidence in infants.
- S. pneumoniae exhibited the highest mortality rate (37.5%). Coma and seizures at admission were associated with increased mortality.
- Overall mortality was 5.6%, with sequelae like mental retardation and hearing loss in 7.2% of survivors.
Impact:
- Highlights the critical role of age in pediatric meningitis etiology.
- Identifies key pathogens and their age-specific incidence rates.
- Emphasizes the prognostic value of clinical signs like coma and seizures for mortality prediction.
- Informs clinical management and public health strategies for pediatric meningitis prevention and treatment.
Unlabelled:
We prospectively studied the epidemiologic, clinic signs and outcome of bacterial meningitis in 125 children who were admitted into a PICU (Pediatric Intensive Care Unit) of 11 hospitals of Spain and whose meningitis was diagnosed between May 1994 and April 1995.
Results:
The median age of the children was 3.55 +/- 3.32 years (range 1 month to 16.5 yrs). Eighty-eight were bacterial meningitis, probably bacterial 30 and aseptic 7. The most frequently isolated organisms were N. meningitidis (52), H. influenza type b (17) and S. pneumoniae (8). Twenty-five percent of N. meningitidis had C serotype. Incidence rate of each germen was depending of age. All patients diagnosed of H. influenza type b meningitis were less than 3 years old. H. influenza type b and meningococcus had similar incidence rate during the first year of life (27% versus 31%). During the first three years of life H. influenza type b produced one third of bacterial meningitis. A mortality rate of 5.6% (seven patients: 3 S. pneumoniae, 1 N. meningitidis, 1 H. influenza type b and 2 unknown germen) was observed. Patients who die had lower Glasgow coma score (p = 0.034) and seizures (p = 0.001) at admission. At discharge of PICU, 9 survivors (7.2%) had sequelae: mental retardation in 7 patients and hearing loss in two. One third of patients needed hemodynamic support and a 15% of them ventilatory support.
Conclusions:
Age is an important epidemiological factor in the etiology of pediatric acute meningitis. H. influenza type b and N. meningitidis had similar incidence rate during the first year of life. S. pneumoniae had the highest mortality rate (37.5%). The presence of coma and seizures at admission were associated with mortality.