Méningites à salmonelles du nouveau-né et du nourrisson. Intérêt des fluoroquinolones

Abstract

To analyze the characteristics of the salmonella meningitis in new-borns and infants in France and sum up the complications and treatments. The observations were taken from the national observatory of bacterial meningitis in children. The medical reports from paediatric and neo-natal departments have been analysed for each patient. The case reports concern 9 newborn babies and infants aged from twelve days to fifteen months (median 4 months). The initial clinical and biologic signs were not specific. Three children had had a digestive infection in the previous weeks, with a positive coproculture for salmonella in two of them. Two infants developed convulsions : 1 of them was hospitalized in intensive care unit ; he also had osteo-articular localisation. All nine children have been treated with third-generation cephalosporins (C3G) and seven of them with quinolones. A newborn who only had cefotaxime and amoxicilline relapsed when the treatment stopped. He showed serious neurological complications and died at the age of eight months. Salmonella meningitis are rare in France (our estimation is 0.2 % of all bacterial meningitis). They are more frequent in "emergent countries" (between 1 to 10 %). In such countries, there are important neurological complications and high relapse rates, often followed by death. Literature study and our observations show that the use of ciprofloxacine reduce the frequency of complications and risk of relapse. The treatment currently advised for salmonella meningitis is to combine in first C3G with quinolone for at least three weeks. Risks of meningitis in case of digestive salmonellosis in infants urge discussion for preventive use of quinolones, particularly before the age of 6 months.