Childhood bacterial meningitis in Pondicherry, South India.
OBJECTIVE
To identify causative bacteria from cerebrospinal fluid (CSF) of children with meningitis and analyse various clinical and laboratory parameters.


METHODS
Over a 20 month period, September 1994 to April 1996, one hundred episodes of acute bacterial meningitis in children aged 1 month-12 years were studied in a tertiary urban hospital in South India. Organisms were isolated from the cerebrospinal fluid (CSF) in 35% of cases. Among infants and children, the two major pathogens were H. influenzae (17%) and S. pneumoniae (12%).


RESULTS
The illness at presentation was mild in 13% and severe in 36% of cases. The association of subdural effusion in children with Salmonella Gp B meningitis merits attention. The overall case fatality rate was 25%. S. pneumoniae had a higher case fatality rate than Salmonella Gp B and H. influenzae (50% vs 17% vs 12%). All the three infants below 3 months of age with S. pneumoniae meningitis died. On analysis of selected clinical and laboratory features by discriminant analysis, CSF culture was the significant (P = 0.02) variable in relation to outcome. In pneumococcal meningitis, CSF WBC count was a highly significant variable in relation to outcome (Wilk's Lambda 0.15, F = 24.64, P = 0.0002).


CONCLUSIONS
Prevention of infections due to H. influenzae and S. pneumoniae should be given higher priority.
Sahai
S
S
Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry-605 006, India.
Mahadevan
S
S
Srinivasan
S
S
Kanungo
R
R
D000704:Analysis of Variance; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006193:Haemophilus influenzae / Q000302:isolation & purification*; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000382:microbiology* / Q000401:mortality / Q000628:therapy; D008583:Meningitis, Haemophilus / Q000134:cerebrospinal fluid / Q000175:diagnosis; D012475:Salmonella / Q000302:isolation & purification*; D012480:Salmonella Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000134:cerebrospinal fluid / Q000175:diagnosis; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*