Probable Bacterial Meningitis Research Articles

Childhood Bacterial Meningitis Surveillance in Southern Vietnam: Trends and Vaccination Implications From 2012 to 2021.

This retrospective hospital-based surveillance aimed to assess the epidemiology, causative pathogens trend, and serotypes distribution of pneumococcal meningitis among children aged under 5 years with bacterial meningitis in Southern Vietnam after the introduction of pentavalent vaccine in the Expanded Program on Immunization (EPI). From 2012 to 2021, cerebrospinal fluid samples were collected from children aged under 5 years with suspected bacterial meningitis at Children's Hospitals 1 and 2 in Ho Chi Minh City. Probable bacterial meningitis (PBM) cases were identified using biochemistry and cytology. Real-time polymerase chain reaction was used to confirm cases of confirmed bacterial meningitis (CBM) caused by Streptococcus pneumoniae, Haemophilus influenzae, or Neisseria meningitidis. Streptococcus pneumoniae serotyping was performed. Of the 2560 PBM cases, 158 (6.2%) were laboratory-confirmed. The CBM proportion decreased during the 10-year study and was associated with age, seasonality, and permanent residence. Streptococcus pneumoniae was the most common pathogen causing bacterial meningitis (86.1%), followed by H influenzae (7.6%) and N meningitidis (6.3%). The case-fatality rate was 8.2% (95% confidence interval, 4.2%-12.2%). Pneumococcal serotypes 6A/B, 19F, 14, and 23F were the most prevalent, and the proportion of pneumococcal meningitis cases caused by the 10-valent pneumococcal conjugate vaccine (PCV) serotypes decreased from 96.2% to 57.1% during the PCV eras. Streptococcus pneumoniae is the most frequent causative agent of bacterial meningitis in children aged under 5 years in Southern Vietnam over the last decade. Policymakers may need to consider introducing PCVs into the EPI to effectively prevent and control bacterial meningitis.

Cerebrospinal Fluid Leucine-Rich Alpha-2 Glycoprotein (LRG) Levels in Children with Acute Bacterial Meningitis.

This study evaluated the diagnostic role of cerebrospinal fluid leucine-rich alpha-2 glycoprotein (CSF LRG) concentration in children with acute bacterial meningitis, and its role in differentiation from aseptic meningitis. CSF LRG concentration was measured by ELISA Kit of 50 children with bacterial meningitis, 16 aseptic meningitis, and 20 children with normal CSF; control. CSF LRG was significantly elevated (p < 0.001) in bacterial meningitis with a sensitivity, specificity, PPV, and NPV of 96%, 100%, 100%, and 90.9%, respectively at a cutoff of 110.0ng/mL, based on ROC curve. At the same cutoff value, CSF LRG has sensitivity, specificity, PPV, and NPV of 96%, 75%, 92.3%, and 85.7%, respectively in differentiating bacterial from aseptic meningitis. However, sensitivity, specificity, PPV, and NPV at 139.9ng/mL for differentiating between definite and probable bacterial meningitis were 88%, 75%, 79.1%, and 84.9%, respectively. CSF LRG should be used as a diagnostic biomarker for bacterial meningitis.

Sentinel surveillance for bacterial pneumonia and meningitis in children under the age of 5 in a tertiary pediatric hospital in Colombia - 2016.

:Introduction: Bacterial pneumonia and meningitis are vaccine-preventable diseases. Sentinel surveillance provides relevant information about their behavior.Objective: To present the data from sentinel surveillance carried out at the Fundación HOMI, Fundación Hospital Pediátrico La Misericordia in 2016.Materials and methods: We conducted a descriptive study from January 1 to December 31, 2016, on the daily surveillance of patients under 5 years of age diagnosed with pneumonia or bacterial meningitis according to PAHO's definitions. We identified the microorganisms using the automated VITEKTM 2 system. Bacterial isolates were sent to the Microbiology Group at the Colombian Instituto Nacional de Salud for confirmation, serotyping, phenotypic, and genotypic characterization. Antimicrobial susceptibility profiles were established.Results: From 1,343 suspected cases of bacterial pneumonia, 654 (48.7%) were probable, 84% had complete Hib vaccination schedules, and 87% had complete pneumococcal vaccination schedules for age. Blood culture was taken in 619 (94.6%) and 41 (6.6%) were positive while S. pneumoniae was isolated in 17 (41%) of them. The most frequent serotype was 19A in five cases (29.4%), and four 19A serotypes were associated with the reference isolate ST320. The incidence rate of probable bacterial pneumonia was 7.3 cases/100 hospitalized patients, and lethality was 2.1%. As for bacterial meningitis, 22 suspected cases were reported, 12 (54%) were probable, four (33%) were confirmed: two by Escherichia coli and two by group C N. meningitidis. The incidence of probable bacterial meningitis was 0.14 cases/100 hospitalized patients.Conclusion:Streptococcus pneumoniae serotypes 19A and 3 were the most frequent cause of pneumonia. Spn19A is related to the multi-resistant clone ST320. Strengthening and continuing this strategy will allow understanding the impact of vaccination.

The Global Landscape of Pediatric Bacterial Meningitis Data Reported to the World Health Organization-Coordinated Invasive Bacterial Vaccine-Preventable Disease Surveillance Network, 2014-2019.

BackgroundThe World Health Organization (WHO) coordinates the Global Invasive Bacterial Vaccine-Preventable Diseases (IB-VPD) Surveillance Network to support vaccine introduction decisions and use. The network was established to strengthen surveillance and laboratory confirmation of meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis.MethodsSentinel hospitals report cases of children <5 years of age hospitalized for suspected meningitis. Laboratories report confirmatory testing results and strain characterization tested by polymerase chain reaction. In 2019, the network included 123 laboratories that follow validated, standardized testing and reporting strategies.ResultsFrom 2014 through 2019, >137 000 suspected meningitis cases were reported by 58 participating countries, with 44.6% (n = 61 386) reported from countries in the WHO African Region. More than half (56.6%, n = 77 873) were among children <1 year of age, and 4.0% (n = 4010) died among those with reported disease outcome. Among suspected meningitis cases, 8.6% (n = 11 798) were classified as probable bacterial meningitis. One of 3 bacterial pathogens was identified in 30.3% (n = 3576) of these cases, namely S. pneumoniae (n = 2177 [60.9%]), H. influenzae (n = 633 [17.7%]), and N. meningitidis (n = 766 [21.4%]). Among confirmed bacterial meningitis cases with outcome reported, 11.0% died; case fatality ratio varied by pathogen (S. pneumoniae, 12.2%; H. influenzae, 6.1%; N. meningitidis, 11.0%). Among the 277 children who died with confirmed bacterial meningitis, 189 (68.2%) had confirmed S. pneumoniae. The proportion of pneumococcal cases with pneumococcal conjugate vaccine (PCV) serotypes decreased as the number of countries implementing PCV increased, from 77.8% (n = 273) to 47.5% (n = 248). Of 397 H. influenzae specimens serotyped, 49.1% (n = 195) were type b. Predominant N. meningitidis serogroups varied by region.ConclusionsThis multitier, global surveillance network has supported countries in detecting and serotyping the 3 principal invasive bacterial pathogens that cause pediatric meningitis. Streptococcus pneumoniae was the most common bacterial pathogen detected globally despite the growing number of countries that have nationally introduced PCV. The large proportions of deaths due to S. pneumoniae reflect the high proportion of meningitis cases caused by this pathogen. This global network demonstrated a strong correlation between PCV introduction status and reduction in the proportion of pneumococcal meningitis infections caused by vaccine serotypes. Maintaining case-based, active surveillance with laboratory confirmation for prioritized vaccine-preventable diseases remains a critical component of the global agenda in public health.The World Health Organization (WHO)-coordinated Invasive Bacterial Vaccine-Preventable Disease (IB-VPD) Surveillance Network reported data from 2014 to 2019, contributing to the estimates of the disease burden and serotypes of pediatric meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis.

Eliminating Lumbar Puncture for Low-Risk Febrile Infants: A Quality Improvement Initiative.

Bacterial meningitis in low-risk febrile young infants (FYIs) aged >28 days has become increasingly rare. Routine performance of lumbar puncture (LP) in these infants is associated with adverse consequences and may be unnecessary. We modified our clinical practice guideline (CPG) to reduce the number of FYIs 29 to 56 days old who receive LP. This quality improvement project sought to modify a preexisting CPG to diagnose and manage FYIs 0 to 56 days old that eliminated routine performance of LP in children 29 to 56 days old who were considered low-risk for serious bacterial infection. The change was implemented by making adjustments to the online CPG. A statistical process control chart was used to assess the affect of the initiative on our primary outcome of LP rate in this population of FYIs. Postimplementation of the CPG initiative, 71% of FYIs 29 to 56 days old did not receive LP, compared with 42% preimplementation. This practice change was also associated with fewer hospitalizations, lower median emergency department (ED) length of stay, and fewer 72-hour ED revisits. Over 3 years of sustained practice, 1/713 (0.1%; 95% confidence interval, 0%-0.8%) low-risk FYI returned within 72 hours and was subsequently treated for probable bacterial meningitis, although cerebrospinal fluid culture was negative for bacterial growth. A change in CPG reduced the number of LPs performed in febrile infants 29 to 56 days old. This change resulted in fewer LPs, hospitalizations, ED revisits, and a lower ED length of stay for FYIs 29 to 56 days old.

Diagnostic Value of Clinical and Laboratory Findings in Childhood Meningitis

Abstract Objective Acute meningitis in childhood is a serious infectious disease that requires immediate medical assessment to ensure appropriate treatment and healthy outcomes. The aim of this retrospective study was to evaluate clinical and laboratory findings in the diagnosis of acute meningitis in children. Materials and Methods Between February 2011 and March 2013, 258 children aged between 1 month and 18 years who were admitted to Konya Training and Research Hospital, Turkey, with clinically suspected meningitis and undergoing lumbar puncture were enrolled in the study. Patient charts were reviewed using a standardized data collection tool. Fifty-nine patients were excluded because of incomplete data or because they did not meet the enrollment criteria. Further statistical analysis was conducted on the remaining 199 patients. The diagnostic values of clinical and laboratory findings for acute meningitis were investigated. IBM SPSS 21.0 for Windows was used for the statistical analysis. Results Of the 199 patients (61.3% male; median age: 24 months), 101 (50.8%) were diagnosed with meningitis. A definitive diagnosis of bacterial meningitis was made in 16 patients, while 5 patients had probable bacterial meningitis. In addition, 80 patients diagnosed as aseptic meningitis and 47 of these patients had human enterovirus meningitis. Headache was more common in patients with meningitis. In patients without meningitis, the most common complaints were seizures or seizures accompanied by fever. Erythrocyte sedimentation rates (ESR), levels of cerebrospinal fluid protein, and cell counts in cerebrospinal fluid examinations were higher in the meningitis group. C-reactive protein, ESR, and procalcitonin higher than 22.55 mg/L, 36.5 mm/hour, and 6.795 mg/mL, respectively, indicated bacterial meningitis. Conclusion Our results showed that a combination of clinical and laboratory markers could facilitate recognition of bacterial meningitis in children.

Validation of multiplex PCR for the diagnosis of acute bacterial meningitis in culture negative cerebrospinal fluid.

This study evaluated the operational characteristics of the multiplex polymerase chain reaction (PCR) for cerebrospinal fluid (CSF) from patients with cellular and biochemical characteristics of acute bacterial meningitis and positive or negative CSF cultures. Multiplex PCR was performed for 36 CSF samples: culture-proven acute bacterial meningitis (n = 7), culture-negative acute bacterial meningitis (n = 17), lymphocytic meningitis (n = 8), and normal CSF (n = 4). The operational characteristics of multiplex PCR were evaluated with definite and probable bacterial meningitis, using culture positive, cytological and biochemical CSF characteristics as the gold standard. Multiplex PCR for CSF was efficient in the group with CSF cellular and biochemical characteristics of acute bacterial meningitis but with a negative CSF culture. This group demonstrated high specificity, positive predictive value, and efficiency. Multiplex PCR for CSF can improve the speed and accuracy of acute bacterial meningitis diagnosis in a clinical setting as a complement to classical immunological and bacteriological assays in CSF. It is also useful for CSF culture-negative acute bacterial meningitis.

Comparative Study of Polymerase Chain Reaction And Routine Microbiological Methods for the Diagnosis Of Pneumococcal Meningitis in Csf

Background: Bacterial meningitis is an important cause of mortality and long term morbidity. Early and accurate diagnosis of bacterial meningitis is of critical concern. Though bacterial culture is considered as gold standard, this approach has some disadvantages with regard to rapidity and sensitivity. This has motivated the evaluation of alternative diagnostic strategy. This study was performed to compare between Polymerase Chain Reaction (PCR) and conventional methods for the diagnosis of pneumococcal meningitis. Materials and Methods: This cross sectional study was carried out in the Department of Microbiology, Chattogram Medical College for cytological examination, biochemical tests, Gram’s stain, culture, and PCR for lytAgene of S.pneumoniae in CSF. Results: Among the 36 cases of probable bacterial meningitis, culture was positive in 12 (33.33%) and Gram’s stain was positive in 9 (25%) cases. Streptococcus pneumoniaewas the predominent organism detected by isolation in 6(50%). PCR detected 14(46.67%) cases of S. pneumoniae among 30 bacterial meningitis cases. All the culture and Gram’s stain positive cases for Streptococcus pneumoniaewere also positive by PCR. The sensitivity, specificity, positive predictive value and negative predictive value of PCR were 100%, 67%, 43%,100% respectively by using CSF culture as gold standard. Conclusion: PCR was highly sensitive and specific and PCR was found superior to other available methods for detection of bacterial meningitis.&#x0D; JCMCTA 2018 ; 29 (2) : 16-21

Meningococcal Disease in Children in Argentina A 3-year Active Sentinel Hospital Surveillance Study.

Meningococcal disease (MD) is a medical emergency and a serious public health problem. As new meningococcal vaccines become available, MD surveillance is crucial to provide baseline epidemiologic data before implementing preventive measures. We estimated MD incidence and epidemiology in Argentina using hospital-based surveillance. Three-year prospective active surveillance in patients ≤15 years of age was conducted at 6 pediatric hospital sentinel units (March 2012 to February 2015). Of 184,360 hospitalized patients, 1444 (0.78%) had suspected meningitis or MD. Of these, 268 (19%) presented probable acute bacterial meningitis or MD, 168 (63%) were culture positive and 51 (30%) tested positive for Neisseria meningitidis. Of 100 culture-negative cases, 30 had positive meningococcal polymerase chain reaction. Thirteen patients presented other uncommon MD manifestations, resulting in a total of 94 MD cases and an annual incidence of 5.1/10 hospitalized patients [95% confidence interval (CI): 4-6]. Fifty-four (57%) patients were males, 48% were <1 year of age and the median age was 12.5 months (1 month to 15 years). Clinical presentations were the following: meningococcemia and meningitis (37%), meningitis (30%), meningococcemia (16%), arthritis (10%), bacteremia (5%) and pneumonia (2%). Twenty-eight percent had complications. Nine children died (case fatality rate: 10%), and 8 had sequelae. Serogroups were identified for 84 isolates. Serogroup W was associated with age <1 year (odds ratio: 3.18; 95% CI: 1.14-8.99); meningococcemia was associated with mortality (P = 0.0038). Highest rates of MD were observed among young infants. This study provides baseline data to estimate the impact of introducing meningococcal vaccines in Argentina.

Evaluation of the line probe assay for the rapid detection of bacterial meningitis pathogens in cerebrospinal fluid samples from children

BackgroundThe aim of this study is to compare the diagnostic performance of the line probe assay (LPA) with conventional multiplex polymerase chain reaction (PCR) for Streptococcus pneumoniae as well as real-time PCR for Neisseria meningitidis and Haemophilus influenzae type b (Hib) in cerebrospinal fluid (CSF) samples from children during the multicenter national surveillance of bacterial meningitis between the years 2006 and 2009 in Turkey.ResultsDuring the study period 1460 subjects were enrolled and among them 841 (57%) met the criteria for probable bacterial meningitis. The mean age of subjects was 51 ± 47 months (range, 1–212 months). We performed the line probe assay in 751 (89%) CSF samples of 841 probable bacterial meningitis cases, of whom 431 (57%) were negative, 127 (17%) were positive for S. pneumoniae, 53 (7%) were positive for H. influenzae type b, and 41 (5%) were positive for N. meningitidis. The LPA was positive in 19 of 23 (82%) S. pneumoniae samples, 4 of 6 (67%) N. meningitidis samples and 2 of 2 (100%) Hib samples in CSF culture-positive cases. The specificity of the LPA for all of S. pneumoniae, H. influenzae type b, and N. meningitidis was 88% (95% CI: 85–91%), when using the standard PCR as a reference. The specificity of LPA for each of S. pneumoniae, H. influenzae type b, and N. meningitidis was 93% (95% CI: 89–95%), 96% (95% CI: 94–98%), and 99% (95% CI: 97–99%), respectively. For all of S. pneumoniae, H. influenzae type b and N. meningitidis the sensitivity of the LPA was 76% (95% CI: 70–82%) and for each of S. pneumoniae, H. influenzae type b and N. meningitidis was 72% (95% CI:63–79%), 88% (95% CI: 73–95%), and 81% (95% CI:67–92%), respectively.ConclusionsThe LPA assay can be used to detect common bacterial meningitis pathogens in CSF samples, but the assay requires further improvement.

Use of administrative records to assess pneumococcal conjugate vaccine impact on pediatric meningitis and pneumonia hospitalizations in Rwanda

BackgroundOngoing surveillance is critical to assessing pneumococcal conjugate vaccine (PCV) impact over time. However, robust prospective studies are difficult to implement in resource-poor settings. We evaluated retrospective use of routinely collected data to estimate PCV impact in Rwanda. MethodsWe collected data from admission registers at five district hospitals on children age <5yearsadmitted for suspected meningitis and pneumonia during 2002–2012. We obtained clinical and laboratory data on meningitis from sentinel surveillance at the national reference hospital in Kigali. We developed multivariable logistic regression models to estimate PCV effectiveness (VE) against severe pneumonia and probable bacterial meningitis and Poisson models to estimate absolute rate reductions. Haemophilus influenzae type b vaccine was introduced in January 2002, PCV7 in April 2009 and PCV13 in August 2011. ResultsAt the district hospitals, the severe pneumonia and suspected meningitis hospitalization rates decreased by 70/100,000 and 11/100,000 children for 2012 compared to baseline, respectively. VE against severe pneumonia calculated from logistic regression was 54% (95% CI 42–63%).In Kigali, from 2002 to 2012, annual suspected meningitis cases decreased from 170 pre-PCV7 to 40 post-PCV13 and confirmed pneumococcal meningitis cases from 7 to 0. VE against probable bacterial meningitis was 42% (95% CI −4% to 68%). ConclusionIn a resource-poor African setting, analysis of district hospital admission logbooks and routine sentinel surveillance data produced results consistent with more sophisticated impact studies conducted elsewhere. Our findings support applying this methodology in other settings and confirm the benefits of PCV in Rwanda.

ABSTRACT 68

Background and aims: Globally, meningitis can lead to a high rate of death and disability in children. Aims: Our aim was to assess the clinical and laboratory features of children with a diagnosis of meningitis in emergency department. Methods: The children admitted to the emergency department with clinically suspected of meningitis and with abnormal cerebrospinal fluid findings (CSF: ≥ 10 WBC per mm3) was included the study. Bacterial meningitis was considered if any following criteria were met in a child with positive CSF culture or positive gram stain. The WHO definition for probable meningitis (CSF with ≥ 100 WBC per mm3, 10–99 WBC per mm3 plus protein concentration ≥100 mg/dL or glucose <40 mg/dL) and high Bacterial Meningitis Score (high BMS= CSF ≥ 10 WBC per mm3 with positive gram stain, CSF neutrophil count ≥ 1000 cells/ mm3, CSF protein ≥100 mg/dL or seizure before or at presentation) were used. Results: A total of 190 children with abnormal CSF findings were included the study. They were classified as aseptic (171, 90%) and bacterial (19, 10%) meningitis. Bulging fontanelle and headache were more common in bacterial meningitis group (p<0.05). Blood procalcitonin levels were higher and CSF glucose levels were lower in bacterial meningitis group (p<0.05). The rate of probable meningitis and high BMS were not different in the groups (p>0.05). In logistic regression analysis, there was no significant parameter for bacterial meningitis diagnosis (p<0.05). Conclusions: Signs, symptoms, proposed criteria for high suspicion of bacterial meningitis, and laboratory findings at admission are not helpful for diagnosis of bacterial meningitis.

Population-based Surveillance for Bacterial Meningitis in China, September 2006–December 2009

During September 2006-December 2009, we conducted active population and sentinel laboratory-based surveillance for bacterial meningitis pathogens, including Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b, in 4 China prefectures. We identified 7,876 acute meningitis and encephalitis syndrome cases, including 6,388 among prefecture residents. A total of 833 resident cases from sentinel hospitals met the World Health Organization case definition for probable bacterial meningitis; 339 of these cases were among children <5 years of age. Laboratory testing confirmed bacterial meningitis in 74 of 3,391 tested cases. The estimated annual incidence (per 100,000 population) of probable bacterial meningitis ranged from 1.84 to 2.93 for the entire population and from 6.95 to 22.30 for children <5 years old. Active surveillance with laboratory confirmation has provided a population-based estimate of the number of probable bacterial meningitis cases in China, but more complete laboratory testing is needed to better define the epidemiology of the disease in this country.

Recognising and Treatment Seeking for Acute Bacterial Meningitis in Adults and Children in Resource-Poor Settings: A Qualitative Study

ObjectiveHigh mortality burden from Acute Bacterial Meningitis (ABM) in resource-poor settings has been frequently blamed on delays in treatment seeking. We explored treatment-seeking pathways from household to primary health care and referral for ABM in Malawi.DesignA cross-sectional qualitative study using narrative in-depth interviews, semi-structured interviews and focus group discussions.ParticipantsAdults and children with proven and probable acute bacterial meningitis and/or their carers; adults from urban and peri-urban communities; and primary health care workers (HCW).SettingQueen Elizabeth Central Hospital (QECH), urban and peri-urban private and government primary health centres and communities in Blantyre District, Malawi.ResultsWhilst communities associated meningitis with a stiff neck, in practice responses focused on ability to recognise severe illness. Misdiagnosis of meningitis as malaria was common. Subsequent action by families depended on the extent to which normal social life was disrupted by the illness and depended on the age and social position of the sufferer. Seizures and convulsions were considered severe symptoms but were often thought to be malaria. Presumptive malaria treatment at home often delayed formal treatment seeking. Further delays in treatment seeking were caused by economic barriers and perceptions of inefficient or inadequate primary health services.ConclusionsGiven the difficulties in diagnosis of meningitis where malaria is common, any intervention for ABM at primary level must focus on recognising severe illness, and encouraging action at the household, community and primary health levels. Overcoming barriers to recognition and social constraints at community level require broad community-based strategies and may provide a route to addressing poor clinical outcomes.

High Likelihood of Meningitis with Late Onset Septicemia in Newborn

Neonatal meningitis must be recognized and treated quickly to prevent death or disability. Incidence of neonatal meningitis with late onset sepsis is higher in developing countries than those of resource-rich countries. In neonates signs and symptoms of serious infections are often obscured and clinical examination cannot distinguish among septic babies with or without meningitis. Clinicians often differ whether neonates undergo lumber puncture or not to distinguish septic babies with or without meningitis. Abnormal CSF findings are often used to detect neonatal meningitis and determine the type and length of antibiotic therapy with proven sepsis and meningitis cases. This study was conducted to evaluate the bacterial meningitis among the late onset sepsis in newborns and to identify the clinical manifestations that can distinguish septicemia from meningitis in neonates. Total 1706 admitted patient in NICU of Bangabandhu Sheikh Mujib Medical University from January 2007 to December 2009 were evaluated retrospectively. Among the 133 (27.94%) cases of suspected late onset sepsis 47(35.33%) were proven sepsis, 63(47.37%) were probable sepsis and 23(17.29%) cases were clinical sepsis based on clinical features laboratory reports and blood cultures. Among the proven sepsis 12(42.85%) cases were found to have definitive bacterial meningitis and 16(57.15%) were probable bacterial meningitis. Among the provable sepsis only 1(12.50%) cases were found to have definite bacterial meningitis and 7 (87.50%) cases were probable bacterial meningitis. There were no meningitis have found among the clinical sepsis. Neonatal meningitis frequently occurred in late onset sepsis. The most frequent presenting clinical features for meningitis cases are more or less similar to those of septicemic cases. The data of the study suggest that newborns with a positive blood culture are significantly more likely to have meningitis than those with a negative blood culture. DOI: http://dx.doi.org/10.3329/jbcps.v30i1.11362 J Bangladesh Coll Phys Surg 2012; 30: 17-23

Diagnostic Accuracy of Cerebrospinal Fluid Gram Stain in Children With Suspected Bacterial Meningitis

This cross-sectional study included 1938 children undergoing lumbar puncture; 21 (1.1%) cases were classified as definite (n = 17) or probable (n = 4) bacterial meningitis. Gram stain sensitivity was 94.1% (95% confidence interval, 71.3%-99.9%) for those with definite meningitis; the positive predictive value was 47.1% (95% confidence interval, 29.8%-64.9%). The sensitivity was 95.2% for those with definite or probable meningitis. Antibiotic pretreatment did not affect results.

Lumbar Puncture in Children from an Area of Malaria Endemicity Who Present with a Febrile Seizure

Although routine lumbar puncture (LP) is often recommended as part of the assessment of fever-associated seizures in children, accumulating evidence questions its value and reveals a decrease in its frequency. Our primary hypothesis was that children who present with a single seizure but with no clinical signs of meningism or coma do not require LP as part of initial diagnostic assessment. We prospectively followed up 377 children aged 2 months through 10 years who presented with at least 1 fever-associated seizure to Modilon Hospital, Madang, Papua New Guinea, from November 2007 through July 2009. Clinical management was performed by hospital staff according to national pediatric guidelines. Of 188 children with a single seizure and 189 children with multiple seizures, 139 (73.9%) and 154 (81.5%), respectively, underwent a LP as part of their initial assessment. Of the 130 children with a single seizure but no evidence of meningism (ie, neck stiffness, positive Kernig's or Brudzinski's sign, and bulging fontanelle) or coma (Blantyre Coma Score 2), none (95% confidence interval, 0%-3.6%) had proven or probable acute bacterial meningitis, and only 1 patient had viral encephalitis (subacute sclerosing panencephalitis). Eighty-one of these children (62.3%) had a final diagnosis of a simple febrile seizure. Proven or probable acute bacterial meningitis was more common in children with a single seizure and meningism or coma (10; 17.2%) and in those with multiple seizures without or with meningism or coma (2 [2.0%] and 30 [33.7%], respectively). Initial LP is unnecessary when careful clinical assessment indicates features of a simple febrile seizure.

Burden of Haemophilus influenzae type B disease in Pakistani children

Estimates of the burden of Haemophilus influenzae type b (Hib) in children in Pakistan are limited. A prospective surveillance was set up in 8 sentinel sites in Karachi and Hyderabad in January 2004. A total of 1481 children aged < 5 years underwent lumbar puncture for suspected acute bacterial meningitis. Specimens from 237 (16.0%) children met the criteria for probable bacterial meningitis, and Hib was detected in 45 of them (19.0%). The minimum detected incidence of Hib meningitis in the Hyderabad area was 7.6 per 100 000 in children < 5 years of age, and 38.1 per 100 000 children < 1 year. Hib vaccination is justified for inclusion in Pakistan's expanded programme of immunization.

Dexamethasone efficacy on bacterial meningitis – a retrospective analysis of Albanian adult patients

Research on the effects of corticosteroids in bacterial meningitis (BM) yielded conflicting results. While some studies reveal that corticosteroids improve the outcomes in BM treatments, others provide strong evidence that patients do not profit from this treatment. We investigated the factors that may impact the dexamethasone efficacy in patients with BM. In this retrospective study, we analyzed the medical records of patients with probable acute bacterial meningitis hospitalized between 2002 and 2008 at the Infectious Diseases Department, University Hospital Centre "Mother Theresa" of Tirana, Albania. They were all treated with dexamethasone. For study purposes, patients were divided into two subgroups: 1) Severely ill patients (Glasgow Coma Scale [GCS] <or= 7 and 2) Less severely ill patients (GCS 8-12). Patients were considered recovered when they reached a GCS >or= 13. Sixty-seven patients analyzed had a mean age of 43.8 +/- 17.0 years old, forty-five (67.2%) of whom were males. The mean recovery time (RT) was 3.5 +/- 1.3 days, and four (6%) died. In the severely ill subgroup (GCS <or= 7 points), the Pearson correlation between the dexamethasone daily dose and the RT was -0.579, p < 0.01 level (2-tailed). There was no correlation found in the less severely ill group of patients (GCS 8-12 points). This study suggests that the patients with lower GCS scores were significantly more likely to benefit from dexamethasone therapy. In this subgroup, high doses of corticosteroids can significantly reduce BM recovery time; however, patients with a high GCS do not benefit from dexamethasone therapy.

Diagnostic Clinical and Laboratory Findings in Response to Predetermining Bacterial Pathogen: Data from the Meningitis Registry

BackgroundChildhood Meningitis continues to be an important cause of mortality in many countries. The search for rapid diagnosis of acute bacterial meningitis has lead to the further exploration of prognostic factors. This study was scheduled in an attempt to analyze various clinical symptoms as well as rapid laboratory results and provide an algorithm for the prediction of specific bacterial aetiology of childhood bacterial meningitis.Methodology and Principal FindingsDuring the 32 year period, 2477 cases of probable bacterial meningitis (BM) were collected from the Meningitis Registry (MR). Analysis was performed on a total of 1331 confirmed bacterial meningitis cases of patients aged 1 month to 14 years. Data was analysed using EPI INFO (version 3.4.3-CDC-Atlanta) and SPSS (version 15.0 - Chicago) software. Statistically significant (p<0.05) variables were included in a conditional backward logistic regression model. A total of 838 (63.0%) attributed to Neisseria meningitidis, 252 (18.9%) to Haemophilus influenzae, 186 (14.0%) to Streptococcus pneumoniae and 55 (4.1%) due to other bacteria. For the diagnosis of Meningococcal Meningitis, the most significant group of diagnostic criteria identified included haemorrhagic rash (OR 22.36), absence of seizures (OR 2.51), headache (OR 1.83) and negative gram stain result (OR 1.55) with a Positive Predictive Value (PPV) of 96.4% (95%CI 87.7–99.6). For the diagnosis of Streptococcus pneumoniae, the most significant group of diagnostic criteria identified included absence of haemorrhagic rash (OR 13.62), positive gram stain (OR 2.10), coma (OR 3.11), seizures (OR 3.81) and peripheral WBC≥15000/µL (OR 2.19) with a PPV of 77.8% (95%CI 40.0–97.2). For the diagnosis of Haemophilus influenzae, the most significant group of diagnostic criteria included, absence of haemorrhagic rash (OR 13.61), age≥1year (OR 2.04), absence of headache (OR 3.01), CSF Glu<40 mg/dL (OR 3.62) and peripheral WBC<15000/µL (OR 1.74) with a PPV of 58.5% (95%CI 42.1–73.7).ConclusionsThe use of clinical and laboratory predictors for the assessment of the causative bacterial pathogen rather than just for predicting outcome of mortality seems to be a useful tool in the clinical management and specific treatment of BM. These findings should be further explored and studied.