[Suppurated pneumococcal meningitis in infants and children: complications and prognostic factors].
This paper investigates 21 patients (16 infants and 5 children) with Pneumococcal meningitis, 15 of which presented with a severe form. Intracranial pressure (IP) monitoring was performed in 7 patients who all had severe (4) or mild (3) intracranial hypertension (IH). Twelve children had a favourable outcome, 7 had sequelae (3 severe) and 2 died from coning, one before monitoring, the second after exhibiting the highest IP and the lowest cerebral perfusion pressure of the series. The 3 children with severe sequelae had a severe form (2) or a mild but prolonged form (1) of IH. The 4 patients who recovered with moderate sequelae presented severe (1), mild IH (1) or were not monitored (2). There were 14 cases with neurological complications. In 8 patients, this seemed to be related to cerebral oedema and IH; coning caused the death of 2 of them; the 6 others exhibited lesions of cerebral oedema on CT-scan, isolated or associated with cerebral infarction or subdural effusion. In the 6 others patients, IP monitoring was not performed; there was no evidence of cerebral oedema on CT-scan; 2 exhibited cerebral infarction and 3 a moderate ventricular dilatation; 2 had hemodynamic problems from acute pneumococcemia in one case and neurovegetative disturbances associated with cerebral infarction in the second. Pneumococcus meningitis remains a severe disease. The prognosis of severe forms can be improved by IP monitoring since IH seems to be the most frequent mechanism of complication.
Pesso
J L
JL
Unité de réanimation pédiatrique, Hôpital Edouard-Herriot, Lyon, France.
Floret
D
D
Cochat
P
P
Dumont
C
C
D001929:Brain Edema / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007427:Intracranial Pressure; D008297:Male; D008586:Meningitis, Pneumococcal / Q000150:complications*; D009422:Nervous System Diseases / Q000209:etiology; D011379:Prognosis; D011559:Pseudotumor Cerebri / Q000209:etiology; D013997:Time Factors
Méningite suppurée à pneumocoque chez le nourrisson et l'enfant: complications et facteurs pronostiques.