Clinical data in children with meningococcal meningitis in a Spanish hospital.
Neisseria meningitidis is the main cause of bacterial meningitis in Spain. Of the 213 children included in this study with meningococcal meningitis, 7 died. Mortality was linked to a shorter time from the first symptom to diagnosis (mean time for fatal cases was 9.5 h, mean time for survivors was 19 h, p = 0.034), to deteriorated consciousness (DC) (mortality rate (MR) with DC = 6/87, MR without DC = 1/124, p = 0.02) and to shock (MR with shock = 5/7, MR without shock = 2/206, p < 0.0001). Previous treatment reduced the yield from blood culture (36/54 versus 45/137, p < 0.0001). Positivity in both Gram stain (GS) and cerebrospinal fluid (CSF) culture increased with longer duration of symptoms (mean GS+ = 25 h, GS- = 16 h, p = 0.004; CSF+ = 20 h, CSF- = 12 h, p = 0.001), and blood culture (BC) gave more positive results when carried out earlier (mean BC- = 14 h, BC- = 24 h, p < 0.001). Reduced susceptibility to penicillin was seen in 34% of the strains, and rapidly evolving forms were responsible for most of the deaths; reduced susceptibility was more frequent among strains responsible for death or sequelae (9/15 = 60%) as compared with the more harmless strains (69/ 215 = 32%) (p = 0.04). The progressive reduction of susceptibility to penicillin indicates that it should be replaced by a third-generation cephalosporine.
Luaces Cubells
C
C
Department of Paediatrics, Unitat Integrada Hospital Clinic-Hospital Sant Joan de Déu, Universitat de Barcelona, Spain.
García García
J J
JJ
Roca Martínez
J
J
Latorre Otín
C L
CL
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008585:Meningitis, Meningococcal / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality; D008826:Microbial Sensitivity Tests; D010403:Penicillin Resistance; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D013997:Time Factors