Acute Bacterial Meningitis In Children Research Articles

Vaccine-preventable Pediatric Acute Bacterial Meningitis in France: A Time Series Analysis of a 19-Year Prospective National Surveillance Network.

In France, vaccination has been implemented against Hi serotype b (Hib), pneumococcus with pneumococcal conjugate vaccines (PCV), and Neisseria meningitidis serogroup C (MenC). These interventions with different coverage and uptake have disrupted the epidemiology of vaccine-preventable acute bacterial meningitis (ABM). We analyzed data from a French prospective surveillance network of ABM in children ≤15 years old enrolled by 259 pediatric wards (estimated national coverage: 61%). From 2001 to 2020, the effect of vaccine implementation was estimated with segmented linear regression. We analyzed 7,186 cases, mainly due to meningococcus (35.0%), pneumococcus (29.8%), and Hi (3.7%). MenC ABM incidence decreased (-0.12%/month, 95% CI: -0.17 to -0.07, P < 0.001) with no change for the overall meningococcal ABM when comparing the pre-MenC vaccination and the post-MenC vaccination trends. Despite a decreasing MenB ABM incidence without a vaccination program (-0.43%/month, 95% CI: -0.53 to -0.34, P < 0.001), 68.3% of meningococcal ABM involved MenB. No change in pneumococcal ABM incidence was observed after the PCV7 recommendation. By contrast, this incidence significantly decreased after the switch to PCV13 (-0.9%/month, 95% CI: -1.6 to -0.2%, P = 0.01). After May 2014, a rebound occurred (0.5%/month, 95% CI: 0.3-0.8%, P < 0.001), with 89.5% of non-PCV13 vaccine serotypes. Hib ABM incidence increased after June 2017. PCV7 and MenC vaccine introduction in France, with slow vaccine uptake and low coverage, had no to little impact as compared to the switch from PCV7 to PCV13, which occurred when coverage was optimal. Our data suggest that MenB and next-generation PCVs could prevent a large part of the ABM incidence in France.

Detection of Enterobacteriaceae in cerebrospinal fluid fluid of neonates with meningitis from tertiary care hospitals.

This study aimed to determine the bacteriological profile of childhood acute bacterial meningitis in Pakistan. The study included a total of 100 children aged between 1 month and 5 years, who were admitted with a diagnosis of meningitis based on clinical findings and positive cerebrospinal fluid (CSF) tests. Out of the 100 CSF samples collected, 21 isolates were confirmed to contain Enterobacteriaceae. The most prevalent Enterobacteriaceae species were Pseudomonas (n=8, 38.09%), Klebsiella (n=4, 19.04%), E. coli (n=4, 19.04%), and Acinetobacter (n=4, 19.04%), while Citrobacter (n=1, 4.76%) was less common. Antibiotic susceptibility patterns were analyzed for these isolates. Pseudomonas (n=8) exhibited 25% resistance to cefepime and 38% resistance to imipenem. Klebsiella (n=4) showed 75% resistance to imipenem. Acinetobacter (n=4) demonstrated 50% resistance to imipenem, along with varying resistance to cefepime, amikacin, ciprofloxacin, and gentamicin. E. coli (n=4) showed 0% resistance to imipenem and amikacin. However, Citrobacter (n=1) showed 0% resistance to ciprofloxacin, aztreonam, gentamicin, amikacin, levofloxacin, and cefepime. Acute bacterial meningitis primarily affects children under 1 year of age. CSF culture revealed that Gram-negative bacteria, specifically Pseudomonas spp., were the predominant pathogens in this family based on Pakistani data.

The Role of Serum Procalcitonin in The Diagnosis and Detection of The Outcome of Acute Bacterial Meningitis in Children

The Role of Serum Procalcitonin in The Diagnosis and Detection of The Outcome of Acute Bacterial Meningitis in Children

Management of Acute Bacterial Meningitis in Children

Background: Meningitis is an infection of the membranes that protect the spinal cord as well as brain. Bacterial meningitis (BM) continues to be a major source of mortality and morbidity in infants and children throughout the world despite of advances in antibiotics. But in Bangladesh, we have not enough research-based information regarding the treatment and outcomes of acute bacterial meningitis in children. Aim of the study: The aim of this study was to evaluate the management of acute bacterial meningitis in children. Methods: This prospective observational study was conducted in the department of Paediatrics, Shaheed Ziaur Rahman Medical College &amp; Hospital, Bogura, Bangladesh during the period from January 2020 to December 2022. In total 47 patients with acute bacterial meningitis were enrolled in this study as study subjects. Proper written consent was taken from all the participants before data collection. As per the inclusion criteria of this study, patients with bacterial meningitis aged between 2 and 16 years were included. All the demographic and clinical data of the participants were recorded. A predesigned questionnaire was used in data collection. All data were processed, analyzed and disseminated using MS Excel and SPSS version 23 program as necessary. Results: In this intervention, as antibiotic therapy, ‘ceftriaxone alone’ was used in the highest number of cases which was used in 36%. Besides this, ‘ampicillin plus gentamycin’, ‘ceftriaxone plus gentamycin’ and ‘crystalline penicillin plus chloramphenicol’ were used in 21%, 28% and 15% cases respectively. On the other hand, steroid was used among 45% patients. Finally in analyzing the outcomes among the participants we observed that, majority of the patients got ‘good outcomes or improvement’ which was in 66%. Poor outcomes were found among one third of total cases (34%). Conclusion: Proper antibiotic selection and timely use of steroids may reduce the complications and deaths among acute ..........

Outcome of Bacterial Meningitis in Children age 1 Month – 12 Years in a Public st SectorHospital Treated with 1 line Antibiotics

Objective: To determine the effectiveness of using first line antibiotics for the treatment of acute bacterial meningitis in children admitted in a public sector hospital and assessing its outcome with the help of data by need for using second line antibiotics therapy and length of stay in hospital. Method: This Crosssectional study was conducted at department of Pediatrics, Pakistan Institute of Medical Sciences, Islamabad over a period of 6 months from January 2019 to July 2019. All children between the age of 1 month – 12 years, of both genders admitted in pediatric ward with acute bacterial meningitis, based on clinical features plus CSF findings, were enrolled in the study. These children were started with first line antibiotic therapy after admission in ward which included ceftriaxone alone or a combination of ampicillin and cefotaxime or cefotaxime plus amikacin depending on age specific recommendations for that age group. All children were closely observed in ward for improvement or deterioration of symptoms. If there was deterioration of symptoms, then second line antibiotics were started which in our case was vancomycin combined with ceftriaxone or meropenem combined with vancomycin. Duration of hospital stay was also noted. Data was analyzed by SPSS version 22. Results: A total of 51 patients were enrolled in the study. Mean age of children in the study was 3.23 ± 3.3 years. There were 33(65.1%) males and 18(34.9%) females. Only 30(58.6%) children were completely vaccinated, rest were either partially vaccinated or not vaccinated at all. ]In the first line antibiotics course, ceftriaxone was the most common antibiotic, which was prescribed to 32(61.3%) children, followed by a combination of cefotaxime with amikacin 13(23.7%) and ampicillin plus cefotaximeto 6(4.3%). Second line therapy was needed in only15(29%) children. The commonly prescribed was a combination of vancomycin and meropenem. The total duration of stay in hospital was for 10-14 days. Conclusion: Our study concluded that first line antibiotic therapy is still an effective treatment for acute bacterial meningitis. So, in the wake of emerging antibiotic resistance, irrational use of antibiotics should be avoided.

Risk Factors for Death and Severe Neurological Sequelae in Childhood Bacterial Meningitis.

Acute bacterial meningitis (ABM) continues to be a challenge from a diagnostic and therapeutic point of view. Identifying severity risk factors and predictive scores may guide interventions to reduce poor outcome. Data from a retrospective study for ABM in children admitted to the Institute of Tropical Medicine in Paraguay was analyzed. ABM was defined as positive cerebrospinal fluid culture, positive latex agglutination, or identification of microorganism by real time-polymerase chain reaction. Univariate and multivariate analyses of risk factors at hospital admission that predicted major morbidity or death during hospitalization were performed. A point-based scoring system that included variables, which were clearly different among those who passed away, was constructed. One hundred fourteen children hospitalized with ABM were eligible for the study. The mean age was 46 ± 57 months (range, 1-192 months). The observed mortality was 33% (38/114 patients). When a point-based scoring system was used, for score of 0 (n = 29) and 1 (n = 12), no death was observed. Among patients with a score of 2 (n = 14), 3 (n = 10 patients), 4 (n = 12 patients), and 5 (n = 13 patients), the mortality rate was 14.3%, 40%, 50%, and 53.8%, respectively. When the score was 6 or higher, the mortality rate was at least 63.6%. The present score accurately discriminated the probability of death in children hospitalized with ABM, and it could be a useful tool to select candidates for admission to the intensive care unit and for adjunctive therapy in clinical trials.

A multicenter epidemiological study of acute bacterial meningitis in children

Objective: To analyze the clinical epidemiological characteristics including composition of pathogens , clinical characteristics, and disease prognosis acute bacterial meningitis (ABM) in Chinese children. Methods: A retrospective analysis was performed on the clinical and laboratory data of 1 610 children <15 years of age with ABM in 33 tertiary hospitals in China from January 2019 to December 2020. Patients were divided into different groups according to age,<28 days group, 28 days to <3 months group, 3 months to <1 year group, 1-<5 years of age group, 5-<15 years of age group; etiology confirmed group and clinically diagnosed group according to etiology diagnosis. Non-numeric variables were analyzed with the Chi-square test or Fisher's exact test, while non-normal distrituction numeric variables were compared with nonparametric test. Results: Among 1 610 children with ABM, 955 were male and 650 were female (5 cases were not provided with gender information), and the age of onset was 1.5 (0.5, 5.5) months. There were 588 cases age from <28 days, 462 cases age from 28 days to <3 months, 302 cases age from 3 months to <1 year of age group, 156 cases in the 1-<5 years of age and 101 cases in the 5-<15 years of age. The detection rates were 38.8% (95/245) and 31.5% (70/222) of Escherichia coli and 27.8% (68/245) and 35.1% (78/222) of Streptococcus agalactiae in infants younger than 28 days of age and 28 days to 3 months of age; the detection rates of Streptococcus pneumonia, Escherichia coli, and Streptococcus agalactiae were 34.3% (61/178), 14.0% (25/178) and 13.5% (24/178) in the 3 months of age to <1 year of age group; the dominant pathogens were Streptococcus pneumoniae and the detection rate were 67.9% (74/109) and 44.4% (16/36) in the 1-<5 years of age and 5-<15 years of age . There were 9.7% (19/195) strains of Escherichia coli producing ultra-broad-spectrum β-lactamases. The positive rates of cerebrospinal fluid (CSF) culture and blood culture were 32.2% (515/1 598) and 25.0% (400/1 598), while 38.2% (126/330)and 25.3% (21/83) in CSF metagenomics next generation sequencing and Streptococcus pneumoniae antigen detection. There were 4.3% (32/790) cases of which CSF white blood cell counts were normal in etiology confirmed group. Among 1 610 children with ABM, main intracranial imaging complications were subdural effusion and (or) empyema in 349 cases (21.7%), hydrocephalus in 233 cases (14.5%), brain abscess in 178 cases (11.1%), and other cerebrovascular diseases, including encephalomalacia, cerebral infarction, and encephalatrophy, in 174 cases (10.8%). Among the 166 cases (10.3%) with unfavorable outcome, 32 cases (2.0%) died among whom 24 cases died before 1 year of age, and 37 cases (2.3%) had recurrence among whom 25 cases had recurrence within 3 weeks. The incidences of subdural effusion and (or) empyema, brain abscess and ependymitis in the etiology confirmed group were significantly higher than those in the clinically diagnosed group (26.2% (207/790) vs. 17.3% (142/820), 13.0% (103/790) vs. 9.1% (75/820), 4.6% (36/790) vs. 2.7% (22/820), χ2=18.71, 6.20, 4.07, all P<0.05), but there was no significant difference in the unfavorable outcomes, mortility, and recurrence between these 2 groups (all P>0.05). Conclusions: The onset age of ABM in children is usually within 1 year of age, especially <3 months. The common pathogens in infants <3 months of age are Escherichia coli and Streptococcus agalactiae, and the dominant pathogen in infant ≥3 months is Streptococcus pneumoniae. Subdural effusion and (or) empyema and hydrocephalus are common complications. ABM should not be excluded even if CSF white blood cell counts is within normal range. Standardized bacteriological examination should be paid more attention to increase the pathogenic detection rate. Non-culture CSF detection methods may facilitate the pathogenic diagnosis.

Acute Bacterial Meningitis in Children with Fever and Fits Aged 6-59 Months Old

Objective: To find out the frequency of acute bacterial meningitis (ABM) in children presented with fever and fits aged 6-59 months old. Methodology: This cross-sectional study was done at The Department of Pediatric Medicine, Bolan Medical College/Hospital Quetta from September 2017 to February 2019. A total of 168 children, of either gender, aged between 6-59 months who presented with 1st episode of febrile seizure, and who arrived at emergency department within 12 hours of episode were included. Samples of cerebrospinal fluid (CSF) were obtained. Later, results were analyzed. Results: Of total 168 patients, 111 (66.1%) were male. The mean age was 27.19±13.80 months while the mean weight and frontooccipital circumference (FOC) was found 12.01 ± 2.05 kg and 48.68 ± 2.77 cm correspondingly. Twenty-four (14.3%) patients were diagnosed with ABM. The most common organism found among 11 positive CSF cultures was Streptococcus pneumonia in 6 (54.6%). Conclusion: Every clinician needs to thoroughly evaluate infants or young children after a simple febrile seizure. Lumber puncture can be done in every child if there is any suspicion of meningitis. Keywords: Acute bacterial meningitis, febrile seizures, fever, fits.

Clinical-epidemiological characteristics of acute bacterial meningitis in children of Khmelnitskyi region (Podilsky region, Ukraine): fifteen-year-long

Acute bacterial meningitis (ABM) leads to a significant number of complications and high mortality. The aim - to analyze the etiological structure, epidemiological, socio-demographic features and complications in ABM in children of Khmelnitskyi region during 2004-2018. Materials and methods. The analysis of 346 cases of ABM, of which 217 boys and 129 girls was conducted. The etiology of meningitis was determined by bacterioscopy, bacteriological sowing, latex agglutination and polymerase chain reaction. Complications were revealed based on the clinical picture and computed tomography and мagnetic resonance imaging. The processing of the results was carried out using analytical method, t-criterion and constructing 95% confidence interval. Results. The disease started with fever 346 (100%), neck stiffness 289 (83.5%) and vomiting 273 (78.9%), less common, alteration of consciousness 28 (8.1%) and seizures 9 (2.6%). The high level of the cytosis were observed in meningococcal (5801.3±4856.7 cells/mm3) and Hib meningitis (5152.6±4153.1 cells/mm3), the lowest level was in pneumococcal meningitis (2601.0±1839.6 cells/mm3). The highest level of liquor protein was in pneumococcal meningitis (179.0±51.0 mg/dl), and the lowest level was in meningococcal meningitis (102.0±49.0 mg/dl) and Hib meningitis (112.0±56.0 mg/dl). The etiological factor was established in 121 (35.0%) of patients. 52 (15.4%) of patients had neurological complications. Conclusions. The majority (58.1%) of ABM are in children under the age of 3. The main causative agent remains N. meningitidis - 57.9%, the second place is S. pneumoniae - 21.5%, the third Hib - 9.9% of cases. Frequent complications were brain edema 32 (61.5%), seizures 19 (36.5%) and hydrocephalus 8 (15.4%). The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the children’s parents was obtained for the research. No conflict of interests was declared by the authors.

The familial experience of acute bacterial meningitis in children. A transversal qualitative study using interpretative phenomenological analysis

IntroductionPediatric acute bacterial meningitis is a life-threatening illness that results from bacterial infection of the meninges and leaves some survivors with significant sequelae. Given the potential trauma induced by the disease itself and the hospitalization, it is important to have an insight on how the parents cope with this aversive event, and especially how they give sense to this experience.Objectives(1) To explore the lived experience of close family ascendants whose child or grandchild had survived acute bacterial meningitis (2) To investigate how they give meaning to this specific experience.MethodsParticipants were recruited through two association of persons affected by meningitis. Convenience sample of eleven family ascendants. Their family descendants were aged between 0.2 and 20 years old at the time of the meningitis diagnosis (M= 4.1, SD= 7.3). In average, 9.4 years had passed between the onset of illness and the relative’s interview (SD= 5.4).Results6 superordinate themes and 2 meaning-making processes were identified: 1. Sick child becoming a “hero” (comparison with other children). 2. Engaged action/attitude: finding the “positive” of the traumatic experience and engaged action to improve the care system.ConclusionsThis is one of the first studies exploring the first-hand experience of family ascendants confronted to acute bacterial meningitis. Findings highlighted factors characterising the disease experience and the psychological adjustment of meningitis survivors’ families. They demonstred (1) the multidimensional impact of the disease on family ascendants and their need for professional psychological support, (2) the importance of direct involvement of parents in identifying key aspects of care.

Acute bacterial meningitis in children with 1st episode of febrile seizures.

Objectives: To find out the frequency of acute bacterial meningitis (ABM) among children with 1st episode of febrile seizures (FS) at a tertiary care hospital. Study Design: Descriptive Cross-sectional study. Setting: Department of Pediatrics Medicine Children’s Hospital and Institute of Child’s Health, Multan. Period: October 2019 to March 2020. Material &amp; Methods: A total number of 169 children who presented with 1st episode of acute FS, aged 6-60 months were included in this study. Data regarding age, gender, residential area and mother education was taken for each children. Once registered, lumbar puncture (LP) was performed along with a random blood sugar. Cerebrospinal fluid (CSF) was collected and analyzed to find out the frequency of FS among children having ABM. Results: Mean age of children was 24.44±12.26 months. There were 100 (59.17%) male children and 69 (40.83%) female children. there were 16 (9.47%) children having positive family history of FS. 97 (57.40%) children were belonged to rural area and rest of the others were belonged to urban area. ABM was found in 10 (5.92%) children. Conclusion: Frequency of ABM among children presented with FS is not high. ABM was diagnosed in 5.92% children presenting with 1st episode of acute FS.

Management of Acute Bacterial Meningitis in Children.

Acute community-acquired bacterial meningitis (ABM) in children continues to have high rates of neurological morbidity and mortality despite the overall declining rates of infection attributed to the use of vaccines and intrapartum Group B Streptococcus prophylaxis. Prompt diagnosis and early antibiotic therapy are crucial and should not be delayed to obtain cranial imaging. Differentiating bacterial from viral meningitis continues to be a clinical dilemma especially in patients with previous antibiotic exposure. Clinical models and inflammatory biomarkers can aid clinicians in their diagnostic approach. Multiplex polymerase chain reaction and metagenomic next-generation sequencing are promising tools that can help in early and accurate diagnosis. This review will present the epidemiology of ABM in children, indications of cranial imaging, role of different models and serum biomarkers in diagnosing ABM, and management including the use of adjunctive therapies and methods of prevention.

Diagnostic accuracy of cerebrospinal fluid lactate in confirmed cases of acute bacterial meningitis in children

Objective:To determine the diagnostic accuracy of cerebrospinal fluid lactate level in confirmed cases of acute bacterial meningitis in childrenMethods:This cross sectional study was conducted in the Department of Paediatrics, King Edward Medical University/ Mayo Hospital, Lahore from January to December 2018. A total of 250 children, between two months - 12 years of age, of both the genders, with suspected acute bacterial meningitis were included by non-probability consecutive sampling. Each child was subjected to lumbar puncture for biochemistry, cytology, culture, and lactate level. CSF lactate level of 1.1-2.4 mmol/L was taken as normal, and >2.4 mmol/L was taken as cut off for acute bacterial meningitis. All collected data was entered and analyzed in SPSS version 22. A 2 x 2 table was made to calculate diagnostic accuracy, sensitivity, specificity, positive and negative predictive value for CSF Lactate.Results:The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of CSF lactate taking CSF culture as gold standard was 100%, 60.61%, 17.27%, 100% and 63.6% respectively, with kappa of 0.19 and p value of 0.000.Conclusion:At a cut off value of 2.4 mmol/L, cerebrospinal fluid lactate level has a high diagnostic accuracy for acute bacterial meningitis.

Osmotic therapies added to antibiotics for acute bacterial meningitis.

BackgroundEvery day children and adults die from acute community‐acquired bacterial meningitis, particularly in low‐income countries, and survivors risk deafness, epilepsy and neurological disabilities. Osmotic therapies may attract extra‐vascular fluid and reduce cerebral oedema, and thus reduce death and improve neurological outcomes.This is an update of a Cochrane Review first published in 2013.ObjectivesTo evaluate the effects of osmotic therapies added to antibiotics for acute bacterial meningitis in children and adults on mortality, deafness and neurological disability.Search methodsWe searched CENTRAL (2017, Issue 1), MEDLINE (1950 to 17 February 2017), Embase (1974 to 17 February 2017), CINAHL (1981 to 17 February 2017), LILACS (1982 to 17 February 2017) and registers of ongoing clinical trials (ClinicalTrials.com, WHO ICTRP) (21 February 2017). We also searched conference abstracts and contacted researchers in the field (up to 12 December 2015).Selection criteriaRandomised controlled trials testing any osmotic therapy in adults or children with acute bacterial meningitis.Data collection and analysisTwo review authors independently screened the search results and selected trials for inclusion. Results are presented using risk ratios (RR) and 95% confidence intervals (CI) and grouped according to whether the participants received steroids or not. We used the GRADE approach to assess the certainty of the evidence.Main resultsWe included five trials with 1451 participants. Four trials evaluated glycerol against placebo, and one evaluated glycerol against 50% dextrose; in addition three trials evaluated dexamethasone and one trial evaluated acetaminophen (paracetamol) in a factorial design. Stratified analysis shows no effect modification with steroids; we present aggregate effect estimates.Compared to placebo, glycerol probably has little or no effect on death in people with bacterial meningitis (RR 1.08, 95% CI 0.90 to 1.30; 5 studies, 1272 participants; moderate‐certainty evidence), but may reduce neurological disability (RR 0.73, 95% CI 0.53 to 1.00; 5 studies, 1270 participants; low‐certainty evidence).Glycerol may have little or no effect on seizures during treatment for meningitis (RR 1.08, 95% CI 0.90 to 1.30; 4 studies, 1090 participants; low‐certainty evidence).Glycerol may reduce the risk of subsequent deafness (RR 0.64, 95% CI 0.44 to 0.93; 5 studies, 922 participants; low to moderate‐certainty evidence).Glycerol probably has little or no effect on gastrointestinal bleeding (RR 0.93, 95% CI 0.39 to 2.19; 3 studies, 607 participants; moderate‐certainty evidence). The evidence on nausea, vomiting and diarrhoea is uncertain (RR 1.09, 95% CI 0.81 to 1.47; 2 studies, 851 participants; very low‐certainty evidence).Authors' conclusionsGlycerol was the only osmotic therapy evaluated, and data from trials to date have not demonstrated an effect on death. Glycerol may reduce neurological deficiency and deafness.

Epidemiology, clinical profile and role of rapid tests in the diagnosis of acute bacterial meningitis in children (aged 1-59 months).

To study the epidemiology, clinical profile, and the role of rapid tests in the diagnosis of acute bacterial meningitis (ABM) in children (1-59 months). A total of 250 cerebrospinal fluid (CSF) and 187 blood samples received from clinically suspected cases of ABM were processed based on standard microbiological protocols. CSF samples were also subjected to antigen and nucleic acid detection. Antibiotic susceptibility testing was done according to the Clinical Laboratory Standards Institute guidelines. Children were also evaluated for outcomes and were followed up until 6 months after discharge. Eighty one cases were reported to be having clinically confirmed ABM, out of which group B Streptococcus was the most common pathogen detected in 49.3% (40) patients followed by Streptococcus pneumoniae, Staphylococcus aureus, Hemophilus influenzae type b, Escherichia coli, Klebsiella pneumoniae, and Neisseria meningitidis ACYW135 in 23.4% (19), 7.4% (6), 6.1% (5), 6.1% (5), 6.1% (5), and in 1.2% (1) patients, respectively. Complications were observed in 54.3% of the children. A follow-up of 6 months after discharge was possible in 39.5% (32) patients among whom sequelae were recorded in 93.7% (30) patients. ABM remains a major cause of neurological sequelae worldwide. Although culture is the gold standard test for its detection, the investigation takes a longer time and the results are influenced by prior antimicrobial therapy. In such cases, rapid tests aid in the early diagnosis of ABM for instituting appropriate management.

Hearing impairment after acute bacterial meningitis in children.

Objective:To determine the incidence of hearing loss after acute episode of meningitis in childrenMethods:A descriptive study carried out in the Department of Pediatric Medicine of The Children’s Hospital Lahore, Pakistan from January 2014 to July 2016. A total of 175 children one month to 13 years of age admitted with diagnosis of meningitis were included. Complete blood count, CSF cytology, biochemistry and culture sensitivity were sent. CT scan brain was done if required. Hearing assessment was done two weeks after admission using otoacoustic emissions in the patients having normal tympanogram. Hearing impairment was classified as sensorineural if otoacoustic emissions were absent while tympanometry was normal.Results:Of 175 children, 58% were males and 42% were females. Mean age was 2.1 years. Orientation as assessed by Glasgow comma scale (GCS) was normal in 63% while 5% had GCS<8 and 32% had GCS between 8 and 15. Signs of meningeal irritation were seen in 58% while focal signs only in 4%. In 15 % cases CT scan was done, out of which 73% showed abnormal findings. Otoacoustic emissions were absent in 22% of cases. Risk factors of hearing deficit were stay duration of more than 10 days (p=0.04), low GCS at presentation (p=0.009) and meningitis with complications (p=0.008).Conclusion:The frequency of hearing loss is 22% following acute episode of meningitis which necessitates the need for implementation of screening assessment after meningitis in Pakistan. Prolonged stay, low GCS and complicated meningitis are risk factors for hearing impairment.

Nested polymerase chain reaction targeting 16S rRNA gene in diagnosis of acute bacterial meningitis

CONTEXT: Diagnosing acute bacterial meningitis (ABM) among children presenting to tertiary health care settings is often difficult because of prior administration of antimicrobials. AIMS: The present study was an attempt to diagnose cases of ABM in children with the help of nested polymerase chain reaction (PCR). SETTINGS AND DESIGN: It is a prospective observational study, in which a total of 84 clinically suspected cases and cerbrospinal fluid (CSF) biochemical parameters suggestive of ABM were included in the study. METHODS AND MATERIAL: CSF samples were subjected to Gram staining, bacterial culture and biochemical identification tests as well as panbacterial nested PCR targeting 16S rRNA gene sequence. Subsequently, a nested multiplex PCR for detection of the three fastidious organisms, viz. Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae, was performed. STATISTICAL ANALYSIS USED: The sensitivity, specificity, PPV, NPV, LR+, and LR− of the tests were calculated. RESULTS: The sensitivity of Gram stain, bacterial culture, and nested PCR targeting 16SrRNA were observed to be 16.21%, 9.45%, and 97.29% respectively. Further, the NPV and LR− the PCR were found to be 83.33 and 0.02 respectively. Species specific nested multiplex PCR was able to detect S. pneumoniae (n = 7), N. meningitidis (n = 2) and H. influenzae (n = 1). CONCLUSIONS: The results indicates that nested PCR targeting 16S rRNA gene may be used in diagnosis of ABM. Further, nested multiplex PCR targeting the three important fastidious bacterial pathogens in ABM cases has showed their presence in our region.

Role of Rifampin in Reducing Inflammation and Neuronal Damage in Childhood Bacterial Meningitis: A Pilot Randomized Controlled Trial.

Treatment of acute bacterial meningitis in children with bactericidal antibiotics causes cell wall lysis and a surge in inflammatory cascade, which in turn contributes to neuronal damage and morbidity. Pretreatment with a nonbacteriolytic antibiotic, such as rifampin, has been shown to attenuate the inflammatory response in experimental models of bacterial meningitis. In a pilot study, in children with bacterial meningitis, we have studied markers of inflammatory response and neuronal damage in 2 groups of children with bacterial meningitis; one group received rifampin pretreatment with ceftriaxone and the other group received ceftriaxone alone. Forty children with bacterial meningitis, who were 3 months to 12 years of age, were randomly assigned to receive either a single dose rifampin (20 mg/kg) 30 minutes before ceftriaxone or ceftriaxone alone was given. The primary outcome variables were cerebrospinal fluid (CSF) concentrations of tumor necrosis factor alpha (TNFα), S100B and neuron-specific enolase on day 1 and day 5, and secondary outcome variables were the values of TNFα and interleukin 6 in serum on day 1 and day 5; hearing and neurologic sequelae at 3 months after recovery from the illness. Children in rifampin pretreatment group had significantly lower CSF TNFα concentrations [median (interquartile range [IQR]): 15.5 (7.2-22.0) vs. 53.0 (9.0-87.5) pg/mL, P = 0.019] and S100B [median (IQR): 145.0 (54.7-450.0) vs. 447.5 (221.0-804.6) pg/mL, P = 0.033] on day 1 and S100B [median (IQR): 109.7 (64.0-287.0) vs. 322 (106.7-578.0) pg/mL, P = 0.048] and neuron-specific enolase [median (IQR): 8.6 (5-14.75) vs. 18.2 (7.0-28.75) ng/mL, P = 0.035] on day 5 when compared with ceftriaxone alone group. The rifampin-treated group also had reduced morbidity and neurologic sequelae; however, these were not statistically significant. Pretreatment with single dose rifampin 30 minutes before ceftriaxone administration reduced the CSF concentrations of markers of inflammation and neuronal damage in children with bacterial meningitis.

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

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.

Different Incidences of Acute Bacterial Meningitis in Children of Central Punjab in Pakistan

Background: Acute Bacterial Meningitis (ABM) is a serious public health problem demanding early diagnosis, effective treatment, prevention, and control. Approximately 70 percent of meningitis cases occur in children under the age of 5 and in adults over the age of 60. Objective: To evaluate the different incidences of Acute bacterial meningitis in children of Pakistan. Setting: different hospitals in central Punjab, Pakistan. Material and methods: It's a retrospective study of case files of admitted children in hospitals of different cities of Pakistan. In this study, we evaluated 135 children's for symptoms of meningitis, diagnosis tests, therapy and also some co-morbid diseases related to ABM. Microsoft excel version 2013 was used for statistical analysis. Main outcome measures: Prevalence of Acute bacterial meningitis in different age groups of children, diagnostic tests, and complications related to acute bacterial meningitis are main findings. Results and discussion: Prevalence of ABM was more in neonates than others. For diagnosis meningitis sign test performed on most patients was not much information, so we can't diagnose complications relating to ABM. Unsatisfactory empirical therapy was given to patients for their treatment. Due to incomplete laboratory identification test, some co-morbid diseases and complications were also observed. There was the total lack of mode of preventions for ABM. Conclusion: It concluded that ABM is serious, death causing disease having the high prevalence in neonates. Furthermore improper diagnosis and non-standard management and treatment cause the disease to be an economic and social burden on the society by increasing long term complications and increase death rate in children.