Transcranial Doppler Ultrasonographic Evaluation of Cerebrovascular Abnormalities in Children With Acute Bacterial Meningitis.

Yudy Fonseca,Helen Malhotra,Davin Ambitapio Musungufu,Tusekile Phiri,Jean Pongo,Stephen Ray,Taty Tshimanga,Montfort Bernard Gushu,Mananu Uchama,Nicole Fortier O'Brien,Bertha Mekiseni Chikaonda,Joseph Bodi Mabiala

doi:10.3389/fneur.2020.558857

Abstract

Introduction: Bacterial meningitis (BM) is a global public health concern that results in significant morbidity and mortality. Cerebral arterial narrowing contributes to stroke in BM and may be amenable to intervention. However, it is difficult to diagnose in resource-limited settings where the disease is common.Methods: This was a prospective observational study from September 2015 to December 2019 in sub-Saharan Africa. Children 1 month−18 years of age with neutrophilic pleocytosis or a bacterial pathogen identified in the cerebrospinal fluid were enrolled. Transcranial Doppler ultrasound (TCD) of the middle cerebral arteries was performed daily with the aim to identify flow abnormalities consistent with vascular narrowing.Results: Forty-seven patients were analyzed. The majority had Streptococcus pneumoniae (36%) or Neisseria meningitides (36%) meningitis. Admission TCD was normal in 10 (21%). High flow with a normal pulsatility index (PI) was seen in 20 (43%) and high flow with a low PI was identified in 7 (15%). Ten (21%) had low flow. All children with a normal TCD had a good outcome. Patients with a high-risk TCD flow pattern (high flow/low PI or low flow) were more likely to have a poor outcome (82 vs. 38%, p = 0.001).Conclusions: Abnormal TCD flow patterns were common in children with BM and identified those at high risk of poor neurological outcome.

Highlights

Bacterial meningitis (BM) is a global public health concern that results in significant morbidity and mortality
Children 1 month−18 years of age were approached for enrollment when diagnosed with BM according to the following criteria: [1] Gram stain or culture of the cerebrospinal fluid (CSF) positive for a bacterial organism OR [2] CSF with ≥100 leukocytes/mm3 with >60% neutrophils
Children with meningococcal meningitis were more likely to have convulsions than children infected with other organisms (n = 14/17 (82%) for N. meningitides vs. n = 10/17 (59%) for S. pneumoniae vs. n = 1/6 (17%) for Salmonella sp., vs. n = 3/5 (60%) for culture-negative meningitis, p = 0.03)

Summary

Methods

This was a prospective observational study from September 2015 to December 2019 in sub-Saharan Africa. Children 1 month−18 years of age with neutrophilic pleocytosis or a bacterial pathogen identified in the cerebrospinal fluid were enrolled. The study was performed from September 2015 to December 2019 at Kalembe Lembe Children’s Hospital in the Democratic Republic of the Congo (DRC), L’Hopital General de Reference de Lodja in the DRC, L’Hopital General de Reference de Nyankunde in the DRC, and Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Children 1 month−18 years of age were approached for enrollment when diagnosed with BM according to the following criteria: [1] Gram stain or culture of the cerebrospinal fluid (CSF) positive for a bacterial organism OR [2] CSF with ≥100 leukocytes/mm with >60% neutrophils (culture-negative meningitis). Children with sickle cell anemia or cerebral malaria were excluded given the high frequency of abnormal TCD findings in these children. CSF was analyzed using the standard methods for cell count, protein, Gram stain, and culture

Results

Discussion

Conclusion