Acute bacterial meningitis in children presenting to The Children's Hospital Lahore before and after pneumococcal vaccine in Pakistan National Immunization Program; A comparison.

Attia Bari,Aizza Zafar,Uzma Jabeen,Hasan Ejaz,Humera Javed,Fatima Zeeshan,Ahsan Waheed Rathore

doi:10.12669/pjms.332.11891

Abstract

Objective:To describe bacteriological profile, morbidity and mortality of acute bacterial meningitis (ABM) in children and to compare these parameters before and after the introduction of Pneumococcal vaccine in Pakistan National Immunization Program.Methods:The present descriptive study was conducted at the Department of Paediatric Medicine of The Children’s Hospital Lahore from January 2012 to December 2015. A total of 503 children one month to five years of age admitted with diagnosis of meningitis were included. Complete blood count, CSF cytology, biochemistry, culture sensitivity and blood culture sensitivity were performed.Results:Frequency of meningitis decreased by 50% in 2013-2015 (199 [2012] vs 304 [2013-2015). Most children in both groups were under one year of age. More neurological complications were seen in the group 2, 20% vs 17%. CSF culture positivity decreased from 12% to 6.6%. Streptococcus pneumoniae isolation decreased from 5 (2.5%) in 2012 to 4 (1.3%) in 2013-2015. Refusal to take feed (p=0.002), impaired sensorium (p=<0.001), severe malnutrition (p=0.001), prolonged duration of symptoms (p=<0.001) and incomplete vaccination status (0.005) were associated with mortality. Mortality rate decreased from 20 (10%) in 2012 to 17 (5.6%) in 2013-2015 but more children developed neurological sequelae 2.7% versus 1%.Conclusion:Acute bacterial meningitis mostly affected children <1 year. Frequency of Streptococcus pneumoniae and mortality of meningitis decreased significantly after PCV but more neurological complications developed in those children who were unvaccinated in 2013-2015 compared to 2012.

Highlights

Acute bacterial meningitis (ABM) is a severe illness mostly affecting children under the age of five years but people of any age can developCorrespondence: November 13, 2016 November 18, 2016 January 31, 2017 February 15, 2017ABM
The diagnosis of central nervous system (CNS) infection is made on examination of cerebrospinal fluid (CSF) and CNS infections can be categorized according to pathogen involved into bacterial, viral, fungal or protozoal.[4]
Our study identified Coagulase negative Staphylococci (CoNS) as the most common organism isolated 11/199 (5.5%) followed by Streptococcus pneumoniae 5/199 (2.5%), H. influenzae and Streptococcus pyogenes in 2012

Summary

Introduction

Acute bacterial meningitis (ABM) is a severe illness mostly affecting children under the age of five years but people of any age can develop. Correspondence: November 13, 2016 November 18, 2016 January 31, 2017 February 15, 2017. Despite advances in medical treatment ABM remains an important cause of childhood morbidity and mortality throughout the world.[1] Neurological sequelae are common in children who suffered from ABM.[2] Fever, vomiting, poor feeding, convulsions, headache, neck stiffness and altered consciousness are common presentations of meningitis in children.[3] The diagnosis of central nervous system (CNS) infection is made on examination of cerebrospinal fluid (CSF) and CNS infections can be categorized according to pathogen involved into bacterial, viral, fungal or protozoal.[4] The exact etiological diagnosis is often not possible, because prior antibiotic therapy, low bacterial load and delay in plating for culture

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