Incidence Of Bacterial Meningitis Research Articles

Cochlear Implant Recipients Have Increased Risk of Meningitis

Cochlear Implant Recipients Have Increased Risk of Meningitis

The changing epidemiology of bacterial meningitis and invasive non-meningitic bacterial disease in scotland during the period 1983-99.

We reviewed population-based laboratory reports of invasive meningococcal, pneumococcal, Haemophilus influenzae, Group B Streptococcus (GBS) and Listeria monocytogenes isolates in order to examine the changing epidemiology of meningitis and invasive non-meningitic disease (INMD) caused by these 5 pathogens in the 2 periods before (1983-91) and after (1992-99) routine use of H. influenzae type B conjugate vaccine (Hib) in Scotland. Neissieria meningitidis was the most common cause of meningitis, accounting for 39.2% of cases of meningitis in 1983-91 and 47% of cases in 1992-99, followed by H. influenzae (31%), Streptococcus pneumoniae (22.4%), GBS (3.9%) and L. monocytogenes (3.5%) in 1983-91 and S. pneumoniae (36.3%), H. influenzae (7.8%), GBS (6.1%) and L. monocytogenes (2.8%) in 1992-99. The important epidemiological features of meningitis and INMD caused by these 5 pathogens between 1983-91 and 1992-99 include: 1. The incidence of bacterial meningitis due to S. pneumoniae and GBS was stable; 2. S. pneumoniae was the predominant cause of INMD in both periods; 3. The incidences of INMD caused by N. meningitidis, GBS and S. pneumoniae increased, by 27%, 55% and 56%, respectively; 4. Decreases in the incidences of bacterial meningitis (by 50%) and INMD (by 50%) due to L. monocytogenes were detected; and 5. There were dramatic reductions in the proportions of bacterial meningitis (by 92%) and INMD (by 56%) due to H. influenzae in vaccinated and non-vaccinated individuals. Continued surveillance is necessary to monitor the disease trend, population at risk, serotype distribution and antimicrobial susceptibility in order to implement appropriate public health interventions against invasive bacterial disease.

Epidemiology of bacterial meningitis among children in Brazil, 1997-1998.

To document the incidence and the descriptive epidemiology of bacterial meningitis among individuals under age 20 in a geographically defined region in Brazil during the two-year period immediately preceding the introduction of Haemophilus influenzae type b (Hib) vaccines into the national immunization program of Brazil. Population-based epidemiological study of all cases of bacterial meningitis reported among residents of Campinas, Brazil, under age 20 (n=316,570) during the period of 1997-98, using comprehensive surveillance records compiled by the Campinas Health Department from cases reported among hospital inpatients, outpatients, emergency room visits, death certificates, and autopsy reports. The incidence of bacterial meningitis (n=274) was 334.9, 115 and 43.5 cases/10(5) person-years (pys) for residents of Campinas under age 1, 5 and 20, respectively. All cases were hospitalized, with an average length of stay of 12 days. Documented prior antibiotic use was 4.0%. The case-fatality rate of bacterial meningitis in individuals under age 20 was 9% (24/274) with 75% of deaths occurring in children under the age of five. The incidence of Hib meningitis (n=26) was 62.8 and 17 cases/10(5) pys in children age <1 and <5, respectively. The incidence of Hib meningitis in children under the age of 5 in Campinas during 1997-98 was similar to that reported in the US, Western Europe, and Israel prior to widespread Hib vaccine use in those regions. This study provides a baseline for later studies to evaluate changes in the etiology and incidence of bacterial meningitis in children after introduction of routine Hib vaccination in Brazil.

Epidemiology of childhood bacterial meningitis in Poland. Incidence of bacterial meningitis with special reference to Haemophilus influenzae type b among children 0-59 months old in the former Kielce and Bydgoszcz districts in Poland in 1998-1999.

Population based surveillance was undertaken to assess the incidence of meningitis caused by Haemophilus influenzae type b in children 0-59 months old in Kielce and Bydgoszcz districts in Poland in 1998 and 1999. The cases were prospectively identified in pediatric and neuroinfection wards of local hospitals where all cases of children with suspected meningitis are referred in both districts. The mean annual incidence of meningitis caused by Haemophilus influenzae type b in children 0-59 months old in Kielce district during the study period was estimated at 3.1 per 100,000 per year (10.3% of cases of bacterial meningitis with confirmed etiology). In Bydgoszcz district, the annual incidence was 9.7 per 100,000 (50% of confirmed cases). These estimations are lower than reported in most Western European countries before the immunization against Hib was introduced. Small numbers of Hib vaccinations reported from both districts do not seem likely to have influenced the data significantly.

Estimating incidence of bacterial meningitis with capture-recapture method, Lazio Region, Italy.

To estimate the incidence of bacterial meningitis in the Lazio Region, including the city of Rome, and to assess the quality of the surveillance systems, we adopted a multiple-capture model by merging cases from three sources available in 1995-1996: the Notifiable Disease Surveillance (NDS) system, the Special Hospital Surveillance (SHS) system and the Hospital Discharge (HD) registry. A medical record revision was carried out to confirm the cases of bacterial meningitis. A total of 199 individuals was classified as probable or confirmed cases of bacterial meningitis in 1995-1996. In this period, the incidence of reported meningitis was 3.8/100,000 (population = 5,209,633). The log-linear model yielded a total estimated number of 236 cases (95% confidence interval (CI): 206-306), the estimate of incidence reaching the value of 4.5/100,000. Hospital Discharge registry showed the highest sensitivity (77%), the SHS system the highest positive predictive value (83%). In 1997-1998, the meningitis surveillance was integrated with an additional laboratory-based source and yielded 326 cases, with an incidence of reported cases of 6.3/100,000. Laboratory surveillance, involving 115 (92%) public hospitals and 84 (57%) private clinics, contributed 35 (27%) cases in addition to those notified to NDS (n = 130). Multiple-capture models, in our experience could estimate the bacterial meningitis incidence with a very good approximation. In order to improve both sensitivity and positive predictive value of surveillance, hospital and public health sources should be integrated with laboratory-based system.

Pediatric septic shock.

1. Stephen M. Schexnayder, MD* 1. 2. *Associate Professor of Pediatrics & Internal Medicine, University of Arkansas for Medical Sciences, Arkansas Children’s Hospital, Little Rock, AR. After completing this article, readers should be able to: 1. Explain how the host’s immune response may cause toxic effects during sepsis. 2. Delineate the cornerstone of resuscitation in patients who have septic shock. 3. List the factors to be considered when prescribing empiric antimicrobial therapy for septic shock. 4. Explain when referral and transport arrangements should be made for patients in septic shock. Despite major advances in vaccines in the past two decades, septic shock continues to be an important pediatric problem. It is a frequent reason for admission to a pediatric intensive care unit, and this complex problem requires prompt recognition and intervention to improve the likelihood of a good outcome. Because the clinical picture of sepsis is not unique to infectious conditions, a number of definitions have been advocated. Investigators in the field have separated the clinical spectrum of sepsis into the categories of bacteremia, systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, and multiple organ dysfunction syndrome. Clinical observations over the past two decades have led to the description of the systemic inflammatory response syndrome (SIRS) and have identified the major role that endothelium plays in the pathogenesis of this disorder. Infection is one of the major causes of SIRS, but a number of other entities, including trauma, acute respiratory distress syndrome, neoplasms, burns, and pancreatitis, also have been recognized as triggers for this complex series of pathophysiologic events. Although initially written with adult vital sign parameters, the principles behind the definitions shown in Table 1⇓ are valid, and modifications have been proposed for applying them to children. View this table: Table 1. Definitions of the Systemic Inflammatory Response Syndrome Sepsis is a recognized important cause of death, with the highest mortality rate occurring among infants. The most recent data report 5.9 deaths per 100,000 population in infants, with the fatality rate decreasing …

National Surveillance System and Hib meningitis incidence in Italy.

In 1994, the Italian Ministry of Health implemented a National Surveillance System to obtain data on the incidence of bacterial meningitis and its causative agents, including Haemophilus influenzae type b (Hib). As a consequence, case reporting of Hib meningitis is increasing year by year; in 1996, there were 126 notifications, of which 73% were in children under 2 years of age. Although underreporting still exists, parallel prospective or retrospective epidemiological surveys conducted in some Italian Regions allowed for partial correction of the incidence of Hib meningitis (up to 18.5/100,000 population in 1994).

Geographic differences in bacterial meningitis: less may be as interesting as more.

Many reports in the last decade have described populations with a high incidence of bacterial meningitis, especially amongst indigenous groups in industrialised countries, such as North American Eskimos and Apache Indians and Australian Aborigines, particularly with meningitis due to Haemophilus influenzae type b (Hib). Lack of evidence that invasive Hib disease, including meningitis, is a significant health problem has been attributed to lack of appropriate data, either due to lack of laboratory and clinical facilities, such as in most less industrialised countries, or lack of study. Host differences in immune response, though known to be important for individual susceptibility to Hib disease and bacterial meningitis, have not been thought important on a population level. Good quality epidemiologic data now available from Hong Kong and Japan, based on sound laboratory methods, have shown bacterial meningitis, particularly due to Hib and Neisseria meningitidis, to be significantly less common than in predominantly Caucasian populations in various industrialised countries. Differences in host immune response to these capsular polysaccharides seems the most likely explanation for this observation. It is interesting that other immunologically mediated disorders such as Kawasaki disease and systemic lupus erythematosis have a relatively high incidence in Sino Japanese populations, lending plausibility to inherited differences in immune response as a mechanism for these observations.

The causative organisms of bacterial meningitis in Korean children, 1986-1995.

Bacterial meningitis remains a serious cause of morbidity and mortality in childhood. Epidemiologic investigations have shown variability in disease risks among different populations and races. In Korea, however, basic epidemiologic information on bacterial meningitis in children is limited. The main purpose of this study was to analyze bacteriologically proven meningitis cases in terms of the relative frequency of causative organisms, mortality rate, and age distribution beyond the neonatal period. Data was obtained from the hospital records who had been diagnosed with bacterial meningitis at 13 general or university hospitals from 1986 through 1995. The patients had at least one positive CSF culture for bacteria. Of 140 cases of CSF culture-proven bacterial meningitis, 46.4% was < or =1 year, 62.1% was < or =2 years, 81.4% was < or =5 years cumulatively. Streptococcus pneumoniae was the most common bacteria responsible for 48 (35.0%) of all cases regardless of age, followed by Haemophilus influenzae for 48 (34.3%) and Neisseria meningitidis for 8 (6.4%) patients. The case fatality rate was 20.0%, 17.1%, and 16.7% for N. meningitidis, S. pneumoniae, and H. influenzae, respectively. In conclusion, the most common organisms of culture-proven bacterial meningitis in the last 10 years have been S. pneumoniae, H. influenzae, and N. meningitidis in order of frequency. Further study should be extended to nation-wide epidemiologic evaluation to show the incidence of bacterial meningitis caused by these three important organisms.

A retrospective epidemiological study of bacterial meningitis in an urban area in Belgium.

In order to obtain epidemiological data on the incidence of bacterial meningitis (BM) before the systematic introduction of vaccination against Haemophilus influenzae type b, a retrospective study of 124 children with proven BM was performed in an urban area in Belgium. N. meningitidis was the most prevalent cause, followed by H. influenzae and S. pneumoniae. Over a period of 6 years the incidence of BM increased ten fold, mainly due to an increase in N. meningitidis. The median age of the children with BM was 17 months and 35% of those with H. influenzae were younger than 1 year. Significant risk factors for BM as a whole were: age under 1 year, male gender, non-Caucasian descent and winter time. These findings may have implications for future vaccination policy in Belgium. Future vaccination schemes in Belgium should take into account than N. meningitis was the prevalent cause of bacterial meningitis and that certain factors increase the risk for developing bacterial meningitis.

Bacterial meningitis in the pediatric population: paradigm shifts and ramifications for otolaryngology-head and neck surgery

Various population-based studies have suggested that the incidence and epidemiology of bacterial meningitis is changing. No studies have been published which examine a sample population of the United States at large. Records of pediatric patients age 5 and under who were treated for bacterial meningitis ( n = 470) at all US Army medical facilities between 1986 and 1991 were reviewed. The incidence of bacterial meningitis declined by 75% in the study group during this period. The largest decrease occurred in infants less than 1 year of age. The bacterial organisms isolated most commonly, in decreasing frequency were: Haemophilus influenza type b (HIB), pneumococcal, streptococcal, and staphylococcal. The most dramatic abatement occurred in Haemophilus meningitis following the introduction of HIB vaccinations. Neurologic sequelae were identified in 10% of meningitis survivors. The 2 most common impairments were hearing loss and speech/language delay. Economic modeling demonstrates tremendous savings in health care dollars from the decrease in disease incidence. These changes will have substantial bearing on training programs and practitioners, since the management of neurologic sequelae requires the expertise of multiple subspecialists. In the face of a medical onslaught, once devastating diseases are in retreat.

The changing spectrum of neonatal meningitis over a fifteen-year period.

One hundred seventy-seven cases of neonatal meningitis treated at the University of Texas Medical Branch at Galveston over a 15-year period (1974-1988) were reviewed. Over this period, the incidence of bacterial meningitis decreased, the incidence of aseptic meningitis remained stable, and the diagnosis of enteroviral meningitis increased in frequency. During 1984-1988, enterovirus was the most common cause of meningitis in neonates older than seven days and accounted for one third of all cases of neonatal meningitis. Half of all neonates with bacterial meningitis had negative blood cultures. We recommend that 1) diagnostic lumbar puncture remain part of the routine assessment of the neonate with suspected sepsis, and 2) CSF be cultured for enterovirus as well as for bacteria when a neonate older than seven days presents with suspected sepsis.

The epidemiology of bacterial meningitis.

The incidence by age and causative organism of bacterial meningitis are not known on a community basis. The epidemiology of bacterial meningitis in a metropolitan county was studied by identifying all cases admitted to a hospital from 1983 through 1987. The overall incidence of bacterial meningitis was 5 per 100,000 person-years, but numbers of cases ranged from 40 per 100,000 for children younger than 5 years to 1.0 per 100,000 in adults aged between 16 and 64 years. No significant excesses of cases were found in male patients or in blacks. The predominant causative organism varied with age. Overall, Haemophilus influenzae was the most common causative organism, but 32 percent of cases were due to Streptococcus pneumoniae. Case fatality rates were high for S. pneumoniae (12.5 percent) and very high for the small number of elderly patients suffering from bacterial meningitis. Significant declines have occurred in the last decade in the incidence of bacterial meningitis in children, particularly in those younger than 5 years, and in disease caused by H. influenzae and group B streptococcus.

Recent advances in the treatment of meningitis, including steroids

Despite advances in antimicrobial chemotherapy, central nervous system infections continue to be an important cause of morbidity and mortality in infants. It is expected that as a result of bacterial vaccine improvements, the incidence of bacterial meningitis will decline in the near future. In the meantime, however, adjunctive therapeutic approaches, oriented to diminish brain inflammation, are proving valuable. An improved prognosis for survivors indicates a normal neurologic outcome for more than 80% of survivors. Other advances include rapid diagnostic techniques for viral and tuberculous central nervous system infections as well as short, intensive chemotherapeutic courses for the latter. Finally, imidazole antifungal agents are of potential value in pediatric infections.

Prevention of Bacterial Meningitis Vaccines and Chemoprophylaxis

The morbidity and mortality caused by bacterial meningitis remains significant despite advances in antimicrobial therapy and supportive care. Prevention of meningitis by routine immunization of infants, who are at greatest risk, offers the only practical way of reducing the incidence of this disease. Widespread use of the recently developed protein conjugate vaccines against Haemophilus influenzae type b by itself could reduce the incidence of bacterial meningitis in the U.S. by more than half. To prevent disease caused by the other pathogens, an effective vaccine against the group B meningococcus must be developed, and the immunogenicity of the pneumococcal and quadrivalent meningococcal vaccines should be improved. Until such time that universal immunization of infants with highly immunogenic vaccines is possible, continued efforts must focus on targeting immunization at high-risk individuals and using chemoprophylaxis to prevent secondary disease where indicated. Addendum: On October 4, 1990, the U.S. Food and Drug Administration licensed the praxis Haemophilus influenzae type b-protein conjugate vaccine (Hboc) for use in infants at 2, 4, and 6 months of age with a booster dose at 15-18 months. Physicians are directed to statements by the Immunizations Practices Advisory Committee and the American Academy of Pediatrics for official recommendations concerning its use.

Changing spectrum of pediatric neurologic disorders during 18 selected years, 1900–1980, at the hospital of university of Tokyo

In order to assess the changing pattern of pediatric neurologic disorders during this century, we retrieved and analyzed the medical records of hospitalized patients with neurologic disorders in our hospital from 1900 to 1980. It was demonstrated that bacterial meningitis had been by far the most common cause of death until 1950. After 1950, both the incidence and the mortality rate of bacterial meningitis declined rapidly probably because of the improved medical care and introduction of various antibiotics. We noticed several interesting features in the changing spectrum of bacterial meningitis as described below. First it was demonstrated that the incidence of tuberculous meningitis declined almost a decade later than those of other kinds of purulent meningitis. Second, the incidence of bacterial meningitis declined even before the introduction of antibiotics. Although the development of antibiotics was the main contributing factor in improving the prognosis for bacterial meningitis, it is suggested from our data that other factors such as improved general supportive care and carrying out of public health programs also played an important role in improving the overall prognosis for bacterial meningitis.

Bacterial Meningitis: Diagnosis and Initial Antibiotic Therapy

Despite advances in antibiotic treatment, bacterial meningitis remains a significant cause of mortality and morbidity among children. In population-based studies in the United States, the incidence of bacterial meningitis is estimated to be 4.6 to 10 per 100,000 population per year. Every year more than two thousand deaths due to bacterial meningitis are reported in the United States, most of these in previously healthy children. This article reviews diagnosis and management of this puzzling disease entity.

Normal Cerebrospinal Fluid Values

To the Editor.— I read with interest the article, "Normal Cerebrospinal Fluid Values in Children: Another Look," by Portnoy and Olson (Pediatrics 1985;75:484-487). Their data certainly have relevance to the problem of interpretation of minimal pleocytosis discovered in the evaluation of the febrile child. Perhaps, because they excluded patients with CNS disease from chart review, they failed to find an additional useful piece of information, ie, the incidence of bacterial meningitis in children with the same or similar CSF pleocytosis.

The incidence of bacterial meningitis in the Netherlands—A comparison of three registration systems, 1977–1982

Data on the incidence of bacterial meningitis (BM) in the Netherlands are important for a cost-benefit analysis of new effective vaccines. During the period 1977-1982 we compared the notifications of meningococcal meningitis, diagnoses on discharge from hospital of all causes of BM (Stichting Medische Registratie, Medical Registration Foundation; SMR) and bacteriological data (Netherlands Reference Laboratory for Bacterial Meningitis; RBM). Notifications of meningococcal meningitis were 42% lower than SMR-data. RBM-registration of meningococcal, haemophilus and pneumococcal meningitis was 20% lower than SMR. Reviewing patient-records we found that these diseases had not been reported in 16% (RBM) and 11% (SMR) of cases. We estimate the incidence of BM during an endemic period at 8.0 per 100 000 population per year, to which the meningococcus contributes 20-25%. In children under 5 years of age the age-specific incidence of haemophilus meningitis is 22/100 000.

Recent advances in management of bacterial meningitis in neonates

The current incidence of neonatal sepsis in the United States varies from less than 1 to 8.1 per 1000 live births. The incidence of bacterial meningitis is about one-third of the number of infants with sepsis. The mortality is 20 to 30% and many survivors are severely impaired. Group B streptococcus and Escherichia coli are the most frequent causes of meningitis. Because of the difficulty of clinical diagnosis, many infants receive presumptive therapy for suspected sepsis or meningitis although few have documented infection. Between 5 and 10% of newborn infants born in the United States receive antimicrobial agents in the nursery, usually a penicillin and an aminoglycoside. To lower the continued high mortality and morbidity of meningitis due to gram-negative enteric bacilli, collaborative randomized trials evaluated the efficacy of gentamicin administered via the intrathecal route, gentamicin administered into the ventricle and most recently, the efficacy of moxalactam. Neither intrathecal or intraventricular drug, both in combination with parenteral drug, was advantageous when compared with parenterally administered drug alone. The mortality rate and number of days of culture positive cerebrospinal fluid were similar in infants who received moxalactam and ampicillin and infants who received amikacin and ampicillin. Adjunctive therapies including granulocyte transfusion, administration of hyperimmune gamma globulin and exchange transfusion are now under investigation. Initial studies of prevention of systemic bacterial infection by prophylactic ampicillin administered to the mother at delivery and use of group B streptococcal vaccine administered to susceptible women in the child bearing age show promise.