A 20-year epidemiological study of pneumococcal meningitis.
We conducted a retrospective analysis of 55 community-acquired Streptococcus pneumoniae meningitis illnesses in Huntington, West Virginia, from 1978 to 1997. Fourteen (36.8%) of 38 adults and 2 (11.8%) of 17 children died. Serotypes 6, 23, 3, and 18 accounted for 20 (41.7%) of 48 strains available for serotyping. Of 40 strains available for antimicrobial susceptibility testing, 1 serotype 19 and 1 serotype 23 strain showed intermediate resistance and a second serotype 23 strain showed high resistance to penicillin; all three patients survived. The case-fatality rates among adults who received penicillin alone, gentamicin in combination, or vancomycin and cephalosporin together were 57.1%, 55.5%, and 60%, respectively, and among those who received chloramphenicol or a third-generation cephalosporin, they were 11.1% or nil, respectively. No child died who received chloramphenicol or vancomycin. Two (33%) of 6 children died who received a third-generation cephalosporin; both were critically ill when initially treated. No child and one adult had received pneumococcal vaccine prior to becoming ill.
Stanek
R J
RJ
Department of Medicine, Marshall University School of Medicine, Huntington, West Virginia 25701-3655, USA.
Mufson
M A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001428:Bacterial Vaccines / Q000276:immunology; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008586:Meningitis, Pneumococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D022242:Pneumococcal Vaccines; D013296:Streptococcus pneumoniae / Q000187:drug effects; D013997:Time Factors
D001428:Bacterial Vaccines; D002556:Cerebrospinal Fluid Proteins; D022242:Pneumococcal Vaccines