Bacterial Meningitis In Children Research Articles

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manifestations were fever (96%), irritability/ lethargy (88%), vomiting (80%), convulsion (75%), unconsciousness (53%) and headache (31%). Signs of meningeal irritation were neck rigidity (57%); kerning’s sign (51%), brudzinki’s sign (45%) and photophobia (28%). Anterior fontanel Bulging were found in (30%) cases. Sensitivity of gram stain of the CSF was 88%. Culture was found positive in 35%. Out of 70 cases of culture positive 52 cases were gram negative and 18 cases were gram positive. Bacteria isolated from CSF were common below 3 years age group and there was very less difference in sex distribution. The bacteria isolated from the CSF culture were pseudomonas, Klebsiella, Acinetobacter, Streptococci pneumonia, Staph. Aureus, E.coli, Gm –ve bacilli, Citrobacter, Proteus, Enterobacter. Overall sensitivity pattern were for meropenem (90%), vancomycin (87.5%), ceftriaxone (85.7%), Amikacin (85.7%), Ceftazidime (82.2%), Piperacillin-Tazobactam (81.4%), Amoxyclav (77.1%), Cefotaxime (70%), Gentamicin (70%), and Netilmicin (70%). Blood and urine culture were positive 5% and 2% respectively. Case fatality rate was 11.5%. Acute bacterial meningitis in children has a considerable mortality, morbidity and serious long term sequelae therefore neurodevelopmental follow up and therapy should begin early. The study concluded that up to eighty percent of all cases of bacterial meningitis admitted to Gajra Raja Medical College were children less than six years old. There is change in the trends of organism causing meningitis. The most common microorganisms responsible were pseudomonas, Klebsiella and Acinetobacter. There is increasing resistance to the commonly used antibiotics like cefotaxime, gentamicin and amoxyclav. Therefore prompt treatment is essential whenever presumed cases of meningitis are encountered so that the incidence of bacterial meningitis and its complications can be reduced.

Accuracy of initial clinical diagnosis of acute bacterial meningitis in children from a malaria-endemic area of Papua New Guinea

The diagnosis of acute bacterial meningitis (ABM) is challenging in resource-limited settings where cerebral malaria and viral encephalitis are also common. To assess the accuracy of an initial clinical diagnosis of ABM in a malaria-endemic area of Papua New Guinea (PNG), a retrospective chart review of hospitalized children aged 2 months to 10 years was conducted. Of the 481 eligible children, 240 had an initial clinical diagnosis of ABM that was confirmed independently by trained research staff under standardized conditions, with laboratory support in only 84 (17.5%; 84/481). When compared with the final laboratory-confirmed diagnosis, an initial diagnosis of ABM had a sensitivity, specificity, positive predictive value and negative predictive value of 76% (95% CI 66-85%), 56% (95% CI 51-61%), 27% (95% CI 21-33) and 92% (95% CI 87-95%), respectively. There was discordance between initial and final diagnosis of ABM in 196 children; 176 initially considered to have ABM had an alternative diagnosis, while 20 without an initial diagnosis of ABM were confirmed to have ABM. These data show that initial misdiagnosis of ABM is common in a malaria-endemic area of PNG. A diagnostic algorithm using standardized assessment for meningeal irritation, coma and malaria parasitological testing needs further evaluation in this setting.

Rapid diagnosis and discrimination of bacterial meningitis in children using gram probe real-time polymerase chain reaction.

In this study, we developed a method of simultaneous detection and discrimination of bacteria in cerebrospinal fluid (CSF) with gram probe real-time polymerase chain reaction (PCR). Our results showed 25 clinical strains representing 13 gram-positive and 12 gram-negative bacterial species. They were identified correctly with the corresponding gram probe. The standard curve showed that the amplification efficiency of templates with different concentrations of bacteria was almost the same with a potential detection limit of 10 colony-forming units/mL. A total of 482 children who were clinically suspected of bacterial meningitis were included in this study. A total of 1.0 mL of CSF was collected from every child and was subjected to gram probe-based PCR (GP-PCR), CSF culture, and CSF routine analysis. The positive rate of the GP-PCR array was (32/482, 6.64%) significantly higher than that of CSF culture (23/482, 4.77%). GP-PCR was proved to be an excellent technique for rapid and accurate diagnosis and discrimination of bacterial meningitis, and hence its use as a diagnostic tool in future seems very promising.

The Role and Reliability of Rapid Bedside Diagnostic Test in Early Diagnosis and Treatment of Bacterial Meningitis

To evaluate the role and reliability of rapid bedside diagnostic test in early diagnosis and treatment of bacterial meningitis in children using reagent strips. This prospective, single blinded study was conducted in the Department of Pediatrics of VMMC & Safdarjung Hospital, New Delhi in collaboration with the Department of Microbiology of VMMC & Safdarjung Hospital, New Delhi, over a period of 15 mo (August 2009 to Nov 2010). Seventy-five children aged 3 mo to 12 y admitted in the pediatric ward with suspected diagnosis of acute meningitis were included. All enroled patients underwent lumbar puncture. CSF samples were taken and divided in 2 parts for laboratory evaluation and rapid strip analysis. The sensitivity, specificity, positive predictive value and the negative predictive values of the reagent strips for the diagnosis of bacterial meningitis were calculated. Accuracy of the reagent strips was established using kappa statistics. Latex agglutination for antigen detection and microbiological culture were also done. Highly significant association was observed between CSF examination in routine laboratory method and dipstick method. The number of laboratory values that correlated were- for cells 71(94.63%), for protein 68 (90.67%), for glucose 68(90.67%) out of total 75 cases. The sensitivity and specificity of reagent strip in diagnosing acute bacterial meningitis were 96.7% and 97.8% respectively. The positive predictive and negative predictive values of reagent strip in diagnosing acute bacterial meningitis were 96.7% and 97.8% respectively. Staphylococcus aureus was found to be the most common organism isolated (50%). Thus reagent strip analysis is a very rapid, reliable and effective method for diagnosis of acute bacterial meningitis in children. Staphylococcus aureus was the most common organism isolated.

Fluctuation in Hearing Thresholds During Recovery From Childhood Bacterial Meningitis

Hearing loss from childhood bacterial meningitis is believed to develop early and have little tendency for recovery. We performed serial hearing evaluations in a large number of children with bacterial meningitis in Luanda, Angola to clarify if, and how often, the result changed. Children with confirmed bacterial meningitis and hearing evaluations on admission, day 7 of treatment and the follow-up visit formed the study group. Hearing was tested by auditory brainstem response audiometry using stimuli of 40 dB, 60 dB and 80 dB. Threshold changes are described between the composite levels of 40/60 dB and 80/>80 dB. In all, 235 ears were tested. While the ≤ 60 dB and ≥ 80 dB levels were maintained through all 3 examinations in 54% and 5% of ears, respectively, changes occurred in 41%. Deterioration from the ≤ 60 dB level to ≥ 80 dB was found in 10% of the ears transiently and in 7% permanently. Improvement from the ≥ 80 dB level to ≤ 60 dB occurred in 22% of the ears. Half of the ears with ≥ 80 dB impairment at the follow-up visit arrived with this finding; the others lost hearing later. Maintaining the ≤ 60 dB level throughout was associated with milder disease (P = 0.003), fewer convulsions (P < 0.0001) and older age (P = 0.009). Almost half of the ears showed threshold changes after admission during recovery from bacterial meningitis, most frequently improvement of initially severely impaired hearing, but some normal ears or with moderate impairment became severely impaired.

Cerebrospinal fluid lactate level as a diagnostic biomarker for bacterial meningitis in children

BackgroundCerebrospinal fluid (CSF) lactate is a potential biomarker for bacterial meningitis in children. To this end, we performed a single-center retrospective cohort study of children from Sao Paulo, Brazil, with CSF pleocytosis to evaluate the ability of CSF lactate to distinguish between children with bacterial and aseptic meningitis. We determined the optimum cutoff point for CSF lactate using receiver-operator curve (ROC) analysis.FindingsWe identified 451 children of whom 40 (9%) had bacterial meningitis. Children with bacterial meningitis had a higher median CSF lactate level [9.6 mmol/l, interquartile range (IQR) 3.2-38.5 mmol/l bacterial meningitis vs. 2.0 mmol/l, IQR 1.2-2.8 mmol/l aseptic meningitis]. A CSF lactate cutoff point of 3.0 mmol/l had a sensitivity of 95% [95% confidence interval (CI) 83-99%), specificity of 94% (95% CI 90-96%) and negative predictive value of 99.3% (95% CI 97.7-99.9%) for bacterial meningitis.ConclusionsIn combination with a validated meningitis clinical prediction rule, the CSF lactate level can be used to distinguish between bacterial and aseptic meningitis in children with CSF pleocytosis.

Clinical analysis of 43 cases of positive culture of cerebrospinal fluid in children

Objective To evaluate the significance of cerebrospinal fluid (CSF) culture in diagnosis and treatment of childhood bacterial meningitis (BM). Methods Clinical data were collected and the etiology, laboratory results, treatment and disease prognosis were analyzed in children with positive CSF culture during Jan 2011 to Dec 2012 in our hospital. Results A total of 43 organisms were detected from CSF, 13 cases of which were clearly diagnosed as BM. The coagulase negative staphylococcus was isolated most frequently (51.2%, 22/43), meanwhile, CSF routine examination and biochemical test were abnormal in only 1 case. All results of blood cultures were negative. All cases were cured without changing antibiotics according to the drug sensitive test. Four strains of Streptococcus agalactiae, 2 strains of Streptococcus pneumoniae and 4 strains of gram-negative bacilli were separated. Routine examinations of all CSF were abnormal in most cases, the CSF biochemical tests were abnormal and blood cultures were positive. Conclusion Coagulase negative staphylococcus separated in most CSF is contaminated bacteria. Streptococcus agalactiae, Streptococcus pneumoniae and gram-negative bacilli separated in CSF have important diagnostic value in BM. Diagnosis of BM should be combined with CSF culture, routine examination, biochemical test, blood culture results and clinical manifestations, then we can avoid unnecessary usage of antibiotics. Key words: Bacterial meningitis; Pathogenic bacteria; Cerebrospinal fluid; Children

Impact des corticoïdes dans la prise en charge immédiate des infections invasives à méningocoque liées aux souches hyper-invasives du complexe clonal ST-11 chez l’enfant

We used data from the Groupe de pathologie infectieuse pédiatrique and Association clinique et thérapeutique infantile du Val-de-Marne (GPIP/ACTIV) National Survey of Bacterial Meningitis in children and the National Reference Center for Meningococci (CNRM) microbiological data to assess the potential impact of corticosteroids on the immediate management of invasive meningococcal disease (IMD) associated with different genotypes, including highly pro-inflammatory strains of the ST-11 clonal complex (genotype ST-11).From 2001 to 2009, 259 pediatric wards and 168 microbiology laboratories distributed throughout France prospectively included all under-18-year-old patients with IMD (meningitis or purpura fulminans). The strains were sent to the CNRM for genotyping. We linked the ACTIV clinical data of IMD cases, where information on corticosteroid therapy was available, to strains isolated by the CRNM.A total of 1981 IMD cases were identified during the 8-year study, 805 cases (712 [88.5%] bacterial meningitis and 93 [11.5%] purpura fulminans) had steroid treatment data (33.8% received corticosteroids). The genotype of the strains was available for 410 patients (24.4% related to genotype ST-11; 100 patients). For all cases and regardless of the corticosteroids, mortality was significantly associated with the genotype ST-11 (OR=2.39, 95% CI [1.29; 4.42], P=0.004). For all cases and regardless of the genotypes of the isolates, mortality was also significantly higher for children with than without corticosteroid therapy (12.7% versus 4.5%, P<0.001). However, this treatment had been prescribed more frequently in severe cases, including shock, PF, coma and/or mechanical ventilation. For children who did not receive corticosteroids, the mortality rate was significantly higher with genotype ST-11 compared to other genotypes (OR=4.68 [1.91, 11.46], P=0.001). This difference disappeared in children who received corticosteroids.This study indicates that in the absence of corticosteroids, higher mortality in invasive meningococcal disease is associated with the ST-11 clonal complex strains. This suggests a possible positive effect of corticosteroid therapy depending on the genotype of the strain involved.

The use of antibiotics and their influence on course and outcome of bacterial meningitis in children before diagnosing it

Bacterial meningitis is a severe infective disease caused by different bacteria during which purulent pyorrhea is created in a subarachnoid space. In clinical terms, it is represented with the appearance of meningeal symptoms and signs. Neither recent years' success accomplished in treatment of bacterial meningitis nor the best organized treatment provide an optimistic prognosis in sick children. Our research was conducted in 91 children with bacterial meningitis. Before diagnosing bacterial meningitis, 50 patients ( 54.9% ) were treated with antibiotic therapy. In this group, 21 patients ( 42% ) showed complications in disease manifested with convulsions in 13 patients (26 % ). In the same group, 29 patients ( 58 % ) had a complete recovery after the treatment while 8 patients ( 16 % ) had sequele. In 41 patients ( 45 % ) without previous antibiotic treatment, complications are registered in 25 patients ( 60.9 % ) as follows: 18 patients ( 43.9 % ) had early complications while 7 patients ( 17.1 % ) had sequele. 16 patients ( 39 % ) had a complete recovery in this group. Complications and sequele are more common in the group of sick children without antibiotic therapy before diagnosing bacterial meningitis. However, the presence of sequele in the group of children which were treated with antibiotics before completed diagnostics showed that treatment of bacterial meningitis must be done in a more effective way as well as an early antibiotics treatment.

Haemophilus influenzae type B meningitis with subdural hygroma

After the introduction of Haemophilus influenzae conjugate vaccine, it is uncommon to see culture-positive cases of invasive H. influenzae disease with complication. It is one of the etiological agents in acute bacterial meningitis in childhood. This case of culture-positive H. influenzae type B meningitis with subdural hygroma as unusual neurological sequelae of Haemophilus type B invasive infection highlights the need of timely vaccination.

Clinical features and predictive factors of recurrent fever observed during the treatment of bacterial meningitis in children

Recurrent fever often occurs during the treatment of bacterial meningitis in children. Few studies have focused on the difference between the patients with and without recurrent fever. The pathogenesis and clinical significance of recurrent fever remain to be elucidated. The objectives of this study were to clarify the clinical features of the patients with recurrent fever, and to identify the predictive factors for recurrent fever in childhood bacterial meningitis. We conducted a hospital-based retrospective chart review and confirmed 52 cases of bacterial meningitis. Recurrent fever was observed in 27 of 52 (52%) patients overall, and 27 of 47 (57%) patients with dexamethasone (DEX) therapy. All patients with recurrent fever received DEX therapy. The mean date of recurrent fever occurrence was 6.2 +/- 2.0 days after admission. The median duration of recurrent fever was 5 days (range 1-19 days). The proportion of patients < 2 years of age was higher in patients with recurrent fever than those without recurrent fever (p = 0.041). Initial peripheral white blood cell count was lower in patients with recurrent fever (p = 0.008). Of the 52 children, 10 (19%) showed neurological sequelae. Neurological sequelae were more frequent in patients with recurrent fever than those without recurrent fever, although this was not statistically significant (p = 0.078). Univariate and multivariate logistic regression analysis showed that the most powerful predictive factor for recurrent fever in patients with DEX therapy was young age (< 2 years) (adjusted odds ratio, 5.1; 95% confidence interval, 1.3-20.7). These results suggest that recurrent fever is related to the two known factors for sequelae, low peripheral white blood cell count and young age. Recurrent fever should be recognized as a possible risk factor for neurological sequelae.

Risk of Bacterial Meningitis in Children With First-time Febrile Seizure

OZET Amac: Bu calismada cocuk acil servisine ilk kez atesli nobet gecirme nedeniyle basvuran cocuklarda lomber ponksiyon yapilma ve akut bakteriyel menenjit gorulme sikliginin arastirilmasi amaclanmistir. Gerec ve Yontem: Calismada 01.01.2011 01.01.2012 tarihleri arasinda cocuk acil servisine ilk atesli nobet tanisi ile kabul edilmis olan ve yaslari 6-60 ay arasinda degisen 85 olgu geriye donuk olarak incelendi. Olgularin ates nedenleri ve ozellikle akut bakteriyel menenjit varligi arastirildi. Lomber ponksiyon yapilma oranlari basit ve komplike nobet grubu ile yas gruplari arasinda (≤12 ay ile >12 ay arasinda) ayri ayri karsilastirildi. Bulgular: Olgularin median yasi 23 ay (ceyrekler arasi genislik:18) olup, % 64,7’si (55/85) erkek, % 35,3’u (30/85) kiz idi. Nobet tipi % 81,2’sinde (69/85) basit, % 18,8’inde (16/85) komplike idi. Olgularin % 10,6’sindan (9/85) kan kulturu, % 10,6’sindan (9/85) BOS kulturu alinmisti. Lomber ponksiyon yapilma sikligi 12 aydan kucuk ve komplike nobet geciren olgularda daha yuksekti (sirasiyla p=0,003 ve p=0,003). Yasi 12 aydan kucuk olan 2 olgunun beyin omurilik sivisinda pleositoz tespit edildi. Ancak beyin omurilik sivisi ve/veya kan kulturunde patojen mikroorganizma ureyen ve bakteriyel menenjit tanisi alan olgu saptanmadi. Olgularin %75,3’u acil servisten taburcu edildi. Bu olgular arasinda 10 gun icinde klinik kotulesme ya da ciddi bakteriyel enfeksiyon nedeniyle hastaneye tekrar yatis tespit edilmedi. Sonuc: Ilk atesli nobet ile acil servise basvuran ve baslangic klinik ve laboratuvar bulgulari merkezi sinir sistemi enfeksiyonunu dusundurmeyen hastalarda bakteriyel menenjit riski oldukca dusuktur. Ancak en ufak bir suphe varliginda LP yapmaktan cekinilmemelidir. Ozellikle 12 ayliktan kucuk ve asilari yasina gore eksik olgularda suphe esiginin dusuk tutulmasi gerektigi dusunulmektedir. Calismadaki olgu sayisinin azligi goz onunde bulundurulmakla birlikte, basit atesli nobetlerde oldugu gibi, komplike nobet geciren hastalarda da lomber ponksiyonun rutin degil, hastalarin klinik bulgulari goz onunde bulundurularak yapilabilecegi dusunulmektedir (CAYD 2014; 1(1):1-8). Anahtar Kelimeler: Atesli nobet, lomber ponksiyon, menenjit

Study of bacterial meningitis in children below 5 years with comparative evaluation of gram staining, culture and bacterial antigen detection.

Bacterial meningitis is one of the most serious infections seen in infants and children, which is associated with acute complications and chronic morbidity. Infections of Central Nervous System (CNS) still dominate the scene of childhood neurological disorders in most of the developing tropical countries. To isolate, identify and determine the antibiotic susceptibility patterns of pathogens associated with bacterial meningitis. We also aimed to comparatively evaluate of Gram staining, culture and bacterial antigen detection in cerebrospinal fluid samples. Present comparative study included 100 CSF samples of children below the age of 5 years, who were clinically suspected meningitis cases. The samples were subjected to Gram staining, culture and Latex agglutination test (LAT). The organisms isolated in the study were characterized and antibiotic susceptibility test was done according to standard guidelines. It was done by using Gaussian test. Of the 100 cases, 24 were diagnosed as Acute bacterial meningitis (ABM) cases by. Gram staining, culture and latex agglutination test. 21 (87.5%) cases were culture positive, with 2 cases being positive for polymicrobial isolates. Gram staining was positive in 17 (70.53%) cases and LAT was positive in 18 (33.33%) cases. Streptococcus pneumoniae was the predominant organism which was isolated and it was sensitive to antibiotics. In the present study, male to female ratio was 1.27:1, which showed a male preponderance. With the combination of Gram staining, culture, and LAT, 100% sensitivity and specificity can be achieved (p < 0.001). Gram staining and LAT can detect 85% of cases of ABM. Bacterial meningitis is a medical emergency and making an early diagnosis and providing treatment early are life saving and they reduce chronic morbidity.

Clinical features of hearing damages caused by bacterial meningitis in children

Objective To explore the prognosis and risk factors of the hearing damages caused by bacterial meningitis in children. Methods A systematic retrospective analysis was carryed out based on their clinical data, the brainstem auditory evoked potential (BAEP) test and follow-up evaluation in 63 pediatric patients diagnosed with bacterial meningitis from Jun. 2011 to May 2013 in Urumqi Children's Hospital. The duration from onset to the first BAEP test, CRP results, ethnics, genders, age white blood cell count, protein and glucose levels in cerebros pinal fluid(CSF) were compared between the BAEP abnormal group and BAEP normal group. Results Fifty children were detected by BAEP. The hearing damage at single or both ears with different severity were found in 22 cases, so the incidence of abnormanity was 44%. Six cases in which were suffered from auditory pathway disorders at a single ear, including 4 cases in left ears, and 2 cases in right ears, while 16 cases were in both ears. Among them, peripheral auditory pathway damages with hearing abnormalities were found in 21 cases. Central auditory pathway damage of brainstem was found only in 1 case. Sixteen cases with BAEP abnormalities were followed up in 1-6 months. Four ears of 3 cases with severe hea-ring damages were not improved and eventually became paratonic sensorineural hearing loss. There was no difference of the duration from onset to the first BAEP test, CRP results, ethnics and genders between the BAEP abnormal group and BAEP normal group (all P>0.05). However, in BAEP abnormal group, the cases of white blood cell count ≥1000×106/L (18 cases), protein≥1.5 g/L(15 cases), glucose levels≤1.0 mmol/L (11 cases), in CSF age≤1 year old (18 cases) were significantly higher those in BAEP normal group (14 cases, 9 cases, 5 cases, 14 cases, respectively)(χ2=5.14, 6.42, 5.85, 5.41, all P<0.05). Conclusions Hearing damages are common complications of the bacterial meningitis in children, and severe hearing damages may difficult to recover in the early stage. The risk factors of hearing damages caused by the bacterial meningitis in children are age, white blood cell count, protein and glucose levels in CSF. It is quite important to finish the early BAEP tests and follow up at regular intervals for bocterial meningitis in chindren. Key words: Bacterial meningitis; Brainstem auditory evoked potential; Hearing damage; Clinical features; Child

Estimating global and regional morbidity from acute bacterial meningitis in children: assessment of the evidence

AimTo estimate global morbidity from acute bacterial meningitis in children.MethodsWe conducted a systematic review of the PubMed and Scopus databases to identify both community-based and hospital registry-based studies that could be useful in estimation of the global morbidity from bacterial meningitis in children. We were primarily interested in the availability and quality of the information on incidence rates and case-fatality rates. We assessed the impact of the year of study, study design, study setting, the duration of study, and sample size on reported incidence values, and also any association between incidence and case-fatality rate. We also categorized the studies by 6 World Health Organization regions and analyzed the plausibility of estimates derived from the current evidence using median and inter-quartile range of the available reports in each region.ResultsWe found 71 studies that met the inclusion criteria. The only two significant associations between the reported incidence and studied covariates were the negative correlation between the incidence and sample size (P < 0.001) and positive correlation between incidence and case-fatality rate (P < 0.001). The median incidence per 100 000 child-years was highest in the African region – 143.6 (interquartile range [IQR] 115.6-174.6), followed by Western Pacific region with 42.9 (12.4-83.4), the Eastern Mediterranean region with 34.3 (9.9-42.0), South East Asia with 26.8 (21.0-60.3), Europe with 20.8 (16.2-29.7), and American region with 16.6 (10.3-33.7). The median case-fatality rate was also highest in the African region (31.3%). Globally, the median incidence for all 71 studies was 34.0 (16.0-88.0) per 100 000 child-years, with a median case-fatality rate of 14.4% (5.3%-26.2%).ConclusionsOur study showed that there was now sufficient evidence to generate improved and internally consistent estimates of the global burden of acute bacterial meningitis in children. Although some of our region-specific estimates are very uncertain due to scarcity of data from the corresponding regions, the estimates of morbidity and case-fatality from childhood bacterial meningitis derived from this study are consistent with mortality estimates derived from multi-cause mortality studies. Both lines of evidence imply that bacterial meningitis is a cause of 2% of all child deaths.

Evolving trends of neonatal and childhood bacterial meningitis in northern Taiwan

The epidemiology of bacterial meningitis varies in different areas, age groups, and times. To know the trend of neonatal and childhood bacterial meningitis in northern Taiwan, we performed this 29-year-long assessment. Eligible patients were aged 18 years or younger, hospitalized in Mackay Memorial Hospital between 1984 and 2012, and proven by positive cerebrospinal fluid bacterial cultures. Analysis included the patient numbers and pathogens in different age groups, periods, complications, and outcomes. Males were predominant in all the age groups through the years. Almost half of the patients were in the neonatal period. Patient numbers went up in the early study period and declined after 1993-1997. Group B Streptococcus and Escherichia coli were the most common pathogens in neonates, whereas in childhood were Streptococcus pneumoniae and Haemophilus influenzae type b (Hib). Patient numbers of Group B Streptococcus, S. pneumoniae, and Hib meningitis declined in the late study period, but E. coli meningitis increased. The mortality rate decreased but sequela rate increased. Among the four most common pathogens, S. pneumoniae had the worst outcome and had highest mortality rate. All Hib meningitis patients survived, but their sequela rate was the highest. This study provides an epidemiological data on trends of neonatal and childhood bacterial meningitis in northern Taiwan during the past 29 years, including male and neonatal predominance, decrease of total patient number in recent years, change of major pathogens, and declined mortality but raised morbidity.

Cerebrospinal Fluid TNF-α, IL-6, and IL-8 in Children With Bacterial Meningitis

ObjectiveWe evaluated the levels of cerebrospinal fluid concentrations of tumor necrosis factor-α, interleukin-6, and interleukin-8 in bacterial meningitis in children. MethodsThe study included children up to 14 years of age admitted to a pediatric ward with fever, headache, vomiting, and seizures. The diagnosis of bacterial meningitis was based on clinical features: physical examination, blood and cerebrospinal fluid cytochemical findings, Gram stain, and bacterial culture. The cerebrospinal fluid levels of tumor necrosis factor-α, interleukin-6, and interleukin-8 were measured in 57 children with bacterial meningitis, 15 with viral meningitis, and 15 controls by enzyme-linked immunosorbent assay methods. ResultsThe mean concentrations of cerebrospinal fluid, tumor necrosis factor-α, interleukin-6, and interleukin-8 were 1108 ± 183, 652 ± 287, and 442 ± 120 pg/mL, respectively, in children with bacterial meningitis and were significantly increased in those in the viral meningitis group (tumor necrosis factor-α : 711 ± 105, IL-6 : 272 ± 161, IL-8 : 175 ± 62 pg/mL; P < 0.001) or control (390 ± 37, 59 ± 17, 19 ± 13 pg/mL, respectively, P < 0.001). At optimum cutoff level based on the receiver operating characteristic curve, cerebrospinal fluid cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-8) showed sensitivity and specificity of 100% for the diagnosis of bacterial meningitis. For differentiation of bacterial from viral meningitis, cerebrospinal fluid level of tumor necrosis factor-α, IL-6, and IL-8 showed sensitivity and specificity of 94.7% and 86.7%, 80.7% and 53.3%, and 89.5% and 86.7%, respectively. ConclusionThe increased concentration of cerebrospinal fluid tumor necrosis factor-α, interleukin-6, and interleukin-8 in children with meningitis suggests a role in the pathogenesis of bacterial meningitis and these levels might prove to be useful in children whose diagnosis is in question.

Invasive Haemophilus influenzae Type b Disease in England and Wales: Who Is at Risk After 2 Decades of Routine Childhood Vaccination?

The introduction of the Haemophilus influenzae serotype b (Hib) conjugate vaccine into national immunization has led to rapid and sustained declines in invasive Hib disease incidence across all age groups. In industrialized countries with established Hib vaccination programs, however, little is known about individuals who develop invasive Hib disease. This study describes the epidemiology of invasive Hib disease in England and Wales during 2000-2012 and the clinical characteristics of laboratory-confirmed Hib cases diagnosed during 2009-2012. Public Health England (PHE) conducts enhanced national surveillance of invasive Hib disease in England and Wales. Detailed clinical information was obtained for all laboratory-confirmed Hib cases diagnosed during 2009-2012. Invasive Hib disease in England and Wales has been declining since 2002, reaching its lowest incidence of 0.02 per 100 000 (14 cases) in 2012. In children aged <5 years of age, Hib incidence was 0.06 per 100 000 (2 cases), compared with 35.5 per 100 000 prior to routine Hib vaccination. Follow-up of all 106 case patients over the 4-year period revealed that most cases occurred in adults (73%) who often had preexisting medical conditions (77%) and presented with pneumonia (56%). The Hib-associated case fatality rate was 9.4% (10/106 cases). Control of Hib disease in England and Wales is currently the best that has been achieved since the introduction of routine Hib vaccination in 1992. Invasive Hib disease is no longer a major cause of acute bacterial meningitis in children but, instead, cases are more likely to present as pneumonia in older adults with comorbidities, similar to the less virulent nonencapsulated H. influenzae.

Unsuccessful validation of 2004 model for predicting academic or behavioural limitations after childhood bacterial meningitis

In 2004, a model identifying children at risk of academic or behavioural limitations after bacterial meningitis (BM) was presented. Risk factors were male gender, low birthweight, lower educational level of the father, Streptococcus pneumoniae, lower cerebrospinal fluid (CSF) leucocyte count, delay between admission and start of antibiotics, dexamethasone <2days, seizures and prolonged fever. The aim of this study was to validate that prediction model in an independent cohort. Academic or behavioural limitations were determined in 93 Dutch school-age BM survivors. Risk factors for limitations were obtained from medical files. Validation was performed by applying the model in the cohort, then assessing discrimination and goodness of fit. Multiple imputation techniques were used to deal with missing values. Although fit of the model appeared good when it came to similarity of expected and observed cases (p-value of the Hosmer-Lemeshow test 0.24-0.57), discrimination was poor. Area under the curve (AUC) of the receiver operated characteristics (ROC) curve of the model was 0.83 (95% CI: 0.77-0.89) in the development cohort and 0.53 (95% CI: 0.41-0.65) in the validation cohort. External validation of the model was unsuccessful. It is not suitable for implementation in practice.

The effect of Haemophilus influenzaetype B and pneumococcal conjugate vaccines on childhood meningitis mortality: a systematic review

BackgroundTwo of the most prevalent causes of severe bacterial meningitis in children, Haemophilus influenzae type B (Hib) and Streptococcus pneumoniae, are preventable by existing vaccines increasingly available in developing countries. Our objective was to estimate the dose-specific effect of Hib and pneumococcal conjugate vaccines (PCV) on childhood meningitis mortality in low-income countries for use in the Lives Saved Tool (LiST).MethodsWe systematically searched and reviewed published vaccine efficacy trials and observational studies reporting the effect of Hib or PCV vaccines on organism-specific meningitis, bacterial meningitis and all-cause meningitis incidence and mortality among children less than five years old in low- and middle-income countries. Data collection and quality assessments were performed using standardized guidelines. For outcomes available across multiple studies (≥2) and approximating meningitis mortality, we pooled estimates reporting dose-specific effects using random effects meta-analytic methods, then combined these with meningitis etiology data to determine the preventable fraction of childhood meningitis mortality for inclusion in LiST.ResultsWe identified 18 studies of Hib conjugate vaccines reporting relevant meningitis morbidity and mortality outcomes (2 randomized controlled trials [RCTs], 16 observational studies) but few provided dose-specific effects. A meta-analysis of four case-control studies examined the dose-specific effect of Hib conjugate vaccines on Hib meningitis morbidity (1 dose: RR=0.64, 95% CI 0.38-1.06; 2 doses: RR=0.09, 95% CI 0.03-0.27; 3 doses: RR=0.06, 95% CI 0.02-0.22), consistent with results from single RCTs. Pooled estimates of two RCTs provided evidence for the effect of three doses of PCV on vaccine-serotype meningitis morbidity (RR=0.16, 95% CI 0.02-1.20). We considered these outcomes of severe disease as proxy estimates for meningitis mortality and combined the estimates of protective effects with meningitis etiology data to provide an estimate of the preventable fraction of childhood meningitis mortality with three doses of Hib (38-43%) and pneumococcal conjugate vaccines (28-35%) for use in LiST.ConclusionsFew RCTs or vaccine effectiveness studies evaluated the dose-specific impact of Hib and PCV vaccines on childhood meningitis mortality, necessitating use of proxy measures to estimate population impact in LiST. Our analysis indicates that approximately three-quarters of meningitis deaths are preventable with existing Hib and PCV vaccines.