PREDICTIVE FEATURES OF MORTALITY AND MORBIDITY DUE TO GROUP B STREPTOCOCCAL (GBS) MENINGITIS

Abstract

Clinical and laboratory features at admission for GBS meningitis have not been assessed as possible predictors of mortality or major neurological sequelae. From 1974 through 1979, 61 patients were admitted with this diagnosis. Infection was rapidly fatal in 13 (21%) and 38 of 48 (79%) survivors were evaluated at a mean of 5.8 years later (range 3.3 to 8.9). Of these 51 infants, 21 (41%) ultimately died or had major neurological sequelae, while 30 (59%) were normal or had minor residuae. Analysis of admission parameters revealed a significant risk of death or major morbidity in patients who had coma or semicoma, decreased peripheral perfusion, total WBC<5,000/mm3, absolute PMN<1,000/mm3, serum HCO3<15 mg/dl and CSF protein>300 mg/dl (p≤0.03,X2 analysis). Features not significantly associated with poor outcome included seizures prior to admission, duration of symptoms ≥ 24 hr. before diagnosis, ratio of immature to total PMN≥0.2, WBC<100/mm3 in CSF, CSF gram stain, and CSF glucose < 10 mg/dl. Among the 14 infants with early-onset meningitis, the mean birth weight of 5 with a fatal outcome (2.056 kg) was significantly less than that of 9 survivors (3.277 kg),(t=3.3, p<0.01). The serious morbidity and mortality declined from 80% (1974) to 25% (1979). Application of these data may allow the prospective identification of patients at high risk for major sequelae associated with GBS meningitis. Furthermore, cautious optimism may be communicated to parents when infants do not have features predictive of major morbidity.