Evaluation of Clinical and Laboratory Findings of Acute Meningitis in Children Below 10 Years.

Abstract

Background: Meningitis is an inflammation of fluid and protective membranes of the brain and spinal cord, it can be difficult to diagnose clinically particularly in young infants who do not seem to reliably display the classic features of the disease. Objective: To describe different cl inical and laboratory findings of acute meningitis among children aged below 10 years. Patients and Methods: A descriptive study comprised One hundred eight patients aged below 10 years had admitted to the emergency department of Child's Central Teaching Hospital diagnosed as meningitis during six months' period from 1 st of February 2017 to 31 st of July 2017. They were subdivided into two groups according to age: infants less than 1 year and children between 1-10 years. Results: The mean age was 2.67±2.4 years. There were 41 patients below 1 year and 67 patients from 1-10 years. Males were significantly more than females in both age groups with male: female ratio of 1.7:1. Sixty-one patients (57%) used antibiotics before doing lumber puncture ( LP), while fortyseven patients (43%) did not use any antibiotics. According to the etiology of meningitis is subdivided into two groups viral and bacterial meningitis, Thirty-eight patients (36%) had viral meningitis, 70(64%) patients had bacterial meningitis, 54 patients of them (50%) were partially treated with antibiotics, and 16 patients (14%) without antibiotic use. Fever was the most common symptom present in viral and bacterial meningitis in a 92% and 99% order. Vomiting and convulsions follow fever in the order of occurrence. Photophobia and headache found only in patients above 1 year. While poor feeding and lethargy were found in both age groups, but was significant in cases below 1 year. Bulging fontanel and irritability were the most common signs in infants with acute meningitis, where neck stiffness, kernig’s sign, and irritability were the most common signs above 1 year aged. CSF glucose was low in 69% of bacterial meningitis, 94% of partially treated bacterial meningitis, and 11% of viral meningitis. CSF protein was high in 88% of bacterial meningitis, 83% of partially treated bacterial meningitis and 8% of viral meningitis. These differences were significant. Leukocytosis was found in 48% of viral meningitis, 71% of partially treated bacterial meningitis, and 75% of bacterial meningitis, these differences were significant. Serum C-RP was positive in 26% of patients with viral meningitis, 37% of patients with partially treated bacterial meningitis, and 94% of patients with bacterial meningitis. Differences were significant. Conclusion: Fever, vomiting, and convulsions were the most common symptoms of meningitis in both age groups. No single clinical feature is diagnostic, and the most accurate is the combination of clinical features to raise suspicion of meningitis. Leukocytosis was found most prominent with bacterial more than viral meningitis.