Pyogenic Meningitis In Children Research Articles

Vaccination Status and Clinical Spectrum of Children with Pyogenic Meningitis in A Tertiary Care Hospital of Hazara Division, Pakistan

Background: Pyogenic meningitis is one of the serious causes of mortality and morbidity in children. It is more prevalent in third world countries with poor vaccination coverage. This study was done to determine the vaccination status and clinical spectrum of pyogenic meningitis in children presenting to a tertiary care hospital.
 Methods: This cross-sectional study was carried out from August, 2017 till January, 2020 over 2.5 years. Records of children who got admitted in pediatric B ward, of either gender between ages of 1 month to 14 years diagnosed as case of pyogenic meningitis were included. Records of vaccination status along with signs of meningeal irritation, complications and outcome during hospital stay were documented. Data was analyzed by SPSS 20 and chi square test applied. P value < 0.05 was taken as significant.
 Results: There were 117 patients, 78 males and 39 females. Age ranged from 1 month to 14 years with mean age of 5.51± 4.19 years. Patients who were vaccinated up to date were 49.6% and 37.6% were not vaccinated at all. Main presenting feature was fever and seizures especially under one year of age. There was significant association between seizures and age group with p value of 0.001. Signs of meningeal irritation (neck stiffness, brudzinski sign, kerning sign) and paradoxical irritability were present in 85 (72.6%) patients mostly above 1 year of age. There was significant association between signs of meningeal irritation and age group (5 years and above) with p value of <0.001. 110 (94%) got discharged and one (0.9%) patient was referred while 6 (5.1%) patients expired. There was significant association between stay duration and vaccination status. (p = 0.018)
 Conclusion: Fever was the most common presentation and vaccinated children with pyogenic meningitis had shorter stay in hospital.

Seven versus Ten Days Antibiotics Course for Acute Pyogenic Meningitis in Children: A Randomized Controlled Trial.

To compare the efficacy and safety of 7 d vs. 10 d empirical antibiotic therapy in cases of acute pyogenic meningitis in children aged 3 mo to 14 y with rapid initial recovery. A total of 96 children aged 3 mo to 14 y with acute pyogenic meningitis were randomized to either 7 d or 10 d therapy on Day 5 of the therapy, if they were in clinical remission and had improving cerebrospinal fluid (CSF) abnormalities. The primary outcome was treatment failure in each group within 10 d of enrolment or relapse of meningitis defined as recurrence of signs and symptoms of meningitis within 2 wk of discharge. Secondary outcome was the presence of sequelae in patient at 30 d and 90 d follow-up post discharge. Out of 111 screened children, 96 patients completed the trial, 48 in each group. There were 7 treatment failures and relapses each in the group receiving 7 d antibiotics while 6 failures and relapses each were seen in 10 d antibiotics group. There was no statistically significant difference in treatment failure in both the groups [2.1 (-0.12-0.16); p = 0.76]. No deaths or significant adverse effects of the drugs occurred during this study. Four cases of nosocomial sepsis were reported with 2 cases in each group. On subsequent 30 d and 90 d follow-up, no statistically significant difference was found between the two groups regarding frequency of hearing impairment, frequency of hydrocephalus [-2.1 (-0.09-0.13); p = 0.65] and various neurological sequelae [6.2 (-0.06-0.19); p > 0.05]. Short course antibiotic therapy may be adequately effective for treatment of acute pyogenic meningitis beyond neonatal age in children with initial rapid recovery.

Aetiology of acute pyogenic meningitis in children in a tertiary care hospital, Kerala

INTRODUCTION: Acute bacterial meningitis is a medical emergency, and the diagnosis is by culture of cerebrospinal fluid (CSF). In this study, we looked at the changing aetiology of acute pyogenic meningitis in the context of the availability of several vaccines. MATERIALS AND METHODS: The aim of this study was to find out the aetiology and antibiotic susceptibility pattern of acute pyogenic meningitis in children between one month and 12 years in one year in a tertiary care centre. A cross-sectional study was conducted in the Department of Microbiology, Medical College Hospital, Trivandrum, in collaboration with Department of Paediatrics, SATH, Trivandrum and Christian Medical College, Vellore. CSF samples were processed by doing Gram-staining and culture in appropriate media. Latex agglutination test (LAT) and PCR were done in all cases for the primary pathogens. Blood culture and sensitivity were also done for all patients. RESULTS: Streptococcus pneumoniae (62.5%) was the most common aetiological agent for acute bacterial meningitis followed by Klebsiella pneumoniae subspp pneumoniae, Group B haemolytic Streptococci and Elizabethkingia meningosepticum. LAT could pick up one culture negative case of pneumococcal meningitis. Blood culture was positive in 37.5% of CSF culture positive cases.

Mondini Dysplasia as a Cause for Recurrent Bacterial Meningitis

Mondini dysplasia is a rare but an important cause for recurrent pyogenic meningitis in children and requires a high index of clinical suspicion for early diagnosis. We present the case of a 7-year-old boy, who presented with 2 episodes of pyogenic meningitis within a span of 1 month. There was no obvious history of hearing abnormalities, but pure tone audiometry suggested profound mixed hearing loss in the left ear. High-resolution computed tomographic scan and magnetic resonance imaging of temporal bones confirmed the diagnosis of Mondini dysplasia in the left ear. Computed tomographic cisternography failed to demonstrate any obvious cerebrospinal fluid leak. The child was managed conservatively and has been asymptomatic since then. Thus, in our patient, Mondini dysplasia as a cause for recurrent pyogenic meningitis was diagnosed (early) during the second episode of meningitis. The need for an early diagnosis of Mondini dysplasia has been stressed in this report.

Presentation And Outcome Of Pyogenic Meningitis In Children: The Experience In Nnewi, Southeast Nigeria

Background: Despite the availability of potent antimicrobial agents, bacterial meningitis continues to carry a high mortality rate. An appreciable number of survivors are affected by neurological deficits, epilepsy and mental retardation. Objectives: To determine the morbidity and mortality patterns of children admitted for bacterial meningitis at the Nnamdi Azikiwe University Teaching Hospital, Nnewi. Design: Retrospective, descriptive Patients and Methods: The medical records of 31 children treated for bacterial meningitis from January 1998 to December 2001 were reviewed Results: 31 children aged 2 months to 14 years, out of a total of 4474 patients, were treated for meningitis (0.69% prevalence rate). Median age was 5 years, with 29% less than 12 months and 45% less than 24 months old. Sex ratio was male 1.4: female 1. Most frequent presenting features were fever, neck stiffness and convulsions. There was a low microbial yield on culture due to prior antibiotic exposure. Treatment was with combinations of ampicillin and chloramphenicol or Penicillin G and chloramphenicol or ceftazidime. 64.5% of patients were discharged well and 32.3% with neurological sequelae. There was one mortality (case fatality 3.2%). 46% of patients were subsequently lost to follow-up. Conclusion: Unrestricted abuse of antibiotics poses a problem in the laboratory diagnosis of bacterial meningitis in this area. Keywords: bacterial meningitis, childhood, morbidity, mortality, sequelae Tropical Journal of Medical Research Vol. 10 (2) 2006: pp. 22-25

内耳奇形による細菌性髄膜炎をきたした２例

Congenital dysplasia is one of the most important cause of a recurrence of pyogenic meningitis in children. It is difficult to preoperatively recognize congenital deformities of the labyrinth because of the varying degrees of hearing loss associated with these deformities. Radiographic examination, especially computed tomography, is useful for detecting any malformation of the osseous labyrinth and classifying these anomalies precisely. We report two cases of recurrent meningitis due to the development of a fistulous communication between the subarachnoid space and the middle ear cavity, classified as incomplete partition and common cavity type. In both cases, CSF-gusher occurred intraoperatively and the vestibule was then packed with an abundance of fibrofatty tissue in the deformed labyrinth. The patients have not demonstrated meningitis recurrence postoperatively.

Epidemiology Of Pyogenic Meningitis Among Children In Barbados: A Population-Based Study Of The Impact Of Hemophilus Influenza Type B Vaccine

Objectives: to describe the changing epidemiology of pyogenic meningitis and Hemophilus influenza type b meningitis prior to and after the introduction of the vaccine. Methods: A population based retrospective study. We conducted a retrospective chart review of all the cases of pyogenic meningitis in children during the twelve years period from 1994 through 2005. Results: Of the 66 cases of pyogenic meningitis, 55(83.3%) of children were < 5 years of age and 40(60.6%) were males. Over all Hemophilus influenza type b was the cause in 50% of all childhood pyogenic meningitis, 56.4% of meningitis in children less than 5 years and 66% of meningitis in children less than 2 years. The mean annual incidence of Hemophilus influenza type b meningitis in under 5 years children decreased from 23.29 per 100, 000 population during 1994 through 2002 when no vaccine was used to 5.5 per 100, 000 population during the 2003 -05 when vaccine was routinely used. Incidence of the pneumococcal meningitis in children under 5 years increased from 14.37 per 100, 000 population during 1994 through 1998 to 42.91 per 100, 000 population during 2001-05. Conclusions: Since the routine use of vaccine, there has been a significant drop in the incidence of Hemophilus influenza type b meningitis. However, the effect of this decline on the over all incidence of pyogenic meningitis has been dampened by an increase in the incidence of pneumococcal meningitis in the recent years.

Invasive Haemophilus influenzae type b infections in Singapore children: a hospital-based study.

A 6-year (1990-95) hospital-based retrospective study was carried out to investigate the pattern of invasive Haemophilus influenzae type b (Hib) disease. Cases with Hib isolated from sterile sites (blood, cerebrospinal fluid, or joint aspirate) were identified from the hospital's microbiological records, and their reviewed case records. Patients with pyogenic meningitis in the same study period were also identified to estimate the incidence of Hib meningitis. Twelve patients had positive cultures from sterile sites, of whom nine children were less than 5 years of age. These included seven cases of meningitis, one patient with acute epiglottitis, and one case of pneumonia. Three of the seven patients with meningitis had significant long-term sequelae. Our data also suggests a relatively low proportion of ethnic Chinese children with invasive disease. It was estimated that 18.4% to 41.1% of pyogenic meningitis in children admitted to the National University Hospital were due to Hib. The estimated annual attack rate of invasive Hib disease was at most 3.3 per 100 000 children aged less than 5 years (95% confidence interval: 2.6-3.5/100 000). : Invasive Hib infections are relatively uncommon in our community. This justifies the need for a cost effectiveness study before a universal Hib vaccination program is implemented.

Pneumococcal and Haemophilus influenzae meningitis in a children's hospital in Ethiopia: serotypes and susceptibility patterns.

Streptococcus pneumoniae and Haemophilus influenzae are responsible for most pyogenic meningitis cases in children in Ethiopia. Resistance of S. pneumoniae and H. influenzae to penicillin and chloramphenicol respectively has been reported globally. Resistance has been related to specific serotypes of S. pneumoniae or to beta-lactamase-producing H. influenzae strains. This study describes the serotypes/ serogroups and susceptibility pattern of the two organisms causing meningitis in Ethiopian children. There were 120 cases of meningitis caused by S. pneumoniae (46) and H. influenzae (74) over a period of 3 years (1993-95). Nineteen children died from pneumococcal and 28 from haemophilus meningitis. Penicillin-resistant pneumococcal meningitis (4/8 = 50%) caused a greater mortality rate than penicillin-susceptible pneumococcal meningitis (15/38 = 39%). Common serotypes accounting for 76% of S. pneumoniae were type 14, 19F, 20, 1, 18 and 5; and serotypes 14, 19F and 7 (accounting for 17% of strains) showed intermediate resistance to penicillin G. 97% of the H. influenzae isolates were type b, and in only two cases beta-lactamase-producing. 72% of isolates of the S. pneumoniae we identified belong to serotypes preventable by a 9-valent vaccine. Our study highlights the possibility of resistant pyogenic meningitis in children in Ethiopia due to emerging resistant strains of S. pneumoniae and H. influenzae isolates.

Haemophilus influenzae disease in children in India: a hospital perspective.

We review and summarize published information on diseases caused by Haemophilus influenzae in India and unpublished data from our center covering more than three decades. Since the mid-1950s H. influenzae has been the most common cause of pyogenic meningitis in children admitted to our hospital, accounting for one-third to one-half of cases. Information from other centers in India has been scanty; the lower frequency of isolation of Haemophilus in studies in some centers may be caused by unsatisfactory media and culture methods. The annual numbers of admissions for pyogenic meningitis in our hospital have been quite similar to the numbers of cases of poliomyelitis. Assuming that the similar numbers of children hospitalized with these two diseases indicate similar incidence rates in the community and taking into account the frequency of Haemophilus isolations in pyogenic meningitis, we estimate that there may be as many as 75 to 100 cases of meningitis caused by this organism per year per 100000 children <5 years of age. Although pneumonia caused by H. influenzae has been recognized in a few studies, information is too scanty to attempt the estimation of incidence. Pus-producing infections caused by Haemophilus are rare. Epiglottitis caused by Haemophilus does not seem to occur in India. In recent years we have found that most invasive Haemophilus infections are caused by H. influenzae type b (Hib); other types or untypable strains are infrequent. An increasing prevalence of resistance to chloramphenicol and ampicillin has been recognized in our center and elsewhere. Thus from a hospital perspective, primary prevention by using Hib vaccine seems to be a rational and beneficial intervention. Community-based studies to measure the disease burden of Hib are urgently needed for a more satisfactory assessment of the need for, and cost benefit of, Hib immunization of all infants.

Pyogenic meningitis in children in north-western Ethiopia

A 5-year retrospective study of all children with acute pyogenic meningitis admitted to a district hospital in north-western Ethiopia was carried out from 1990 to 1994. A total of 132 cases of pyogenic meningitis were identified. The causative bacteria were identified in 85 (64%) patients. The most common pathogen was Haemophilus influenzae (40%) with a case fatality rate of 29.4%, followed by Neisseria meningitidis (36.4%), which had a case fatality rate of 16.1%, and Streptococcus pneumoniae (20%) with a case fatality rate of 35.3%. Boys accounted for 64% of the patients, giving a male:female ratio of 1.7:1. Median patient age was 0.75 years, and median ages of those infected by H. influenzae, N. meningitidis, and S. pneumoniae were 0.5, 4.0 and 0.6 years, respectively. The overall case fatality rate was 28%. The mortality rate of children below the age of 1 year was 38.4% and 13.8% for those above 1 year.

Levels of cerebrospinal fluid and serum acetylcholinesterase in Tuberculous and pyogenic meningitis in children

Total acetylcholinesterase activity (AChE) was estimated in CSF and serum of 163 cases, comprising of 64 cases of Tuberculous meningitis (TBM), 60 cases of pyogenic meningitis (PM) and 30 control in the paediatric age group. Mean CSF-AChE levels were 7.94±0.38, 9.06±0.16 and 9.80±0.30 unit/ml (Mean±S.E.) in Control, TBM and PM respectively. The respective serum AChE levels were 2.65±0.13, 3.18±0.07 and 3.93±0 0.035 units/ml. The ratio of CSF/serum-AChE in three groups were 3.09±0.137 (Mean±S.E.), 2.88±0.087, 2.98±0.092 in control, TBM and PM respectively. The values in both CSF as well as in serum in patient with TBM and in PM were significantly higher as compared to controls. However, the differences between the mean CSF-AChE and serum-AChE levels and CSF-AChE/serum-AChE were insignificant. Thus, though AChE levels are raised in meningitis, they are not helpful in differentiating TBM from PM.

Levels of cerebrospinal fluid acetylcholinesterase in tuberculous and pyogenic meningitis in children

Levels of cerebrospinal fluid acetylcholinesterase in tuberculous and pyogenic meningitis in children

Amoxycillin injection in the treatment of pyogenic meningitis in children.

An open trial of the use of amoxycillin injection in the treatment of pyogenic meningitis in children showed similar results to previous trials here of penicillin-chloramphenicol combinations. It is felt that, in developing countries at least, treatment of pyogenic meningitis in children should be with the latter combination, but where rapid and accurate bacteriology is available amoxycillin may be valuable non-toxic alternative to chloramphenicol with similar activity to ampicillin.

Clinical and bacteriological study of pyogenic meningitis in children.

33 cases of pyogenic meningitis seen at the children’s hospital medical college, Kanpur, have been reviewed. The highest incidence occurred in the months of January to February and September to October with a decline during the summer months. No age group was spared though the maximum incidence was noted in the age group between 5–10 years. In most of the cases (42.4%) it appeared to be a primary involvement of the leptomeninges, as no specific focus of infection elsewhere could be detected. The common offending organisms wereStrep. hemolyticus andStaph. aureus. Response to chemotherapy was excellent. Corticosteroids used intrathecally in 3 cases resulted in improvement in the C.S.F. No neurological complication occurred in any case. The mortality rate was 9.1%.

Acute pyogenic meningitis in children in the North-East of Scotland.

Acute pyogenic meningitis in children in the North-East of Scotland.