[Pneumococcal meningitis in children: clinical findings, most frequent serotypes and outcome].
OBJECTIVE
To determine mortality, morbidity, antimicrobial susceptibility and the most frequent serotypes in children admitted to hospital due to pneumococcal meningitis


METHODS
Patients with meningitis caused by Streptococcus pneumoniae detected by culture in cerebrospinal fluid or blood, aged between 1 month and 15 years old, admitted to two hospitals in the city of São Paulo, were included in the study. Susceptibility to penicillin was determined by the disk diffusion test using oxacillin 1 microg disk. If the inhibition area with oxacillin disk was less than 20mm, the strains were tested for penicillin, chloramphenicol, ceftriaxone, vancomycin and sulfamethoxazole /trimethoprim using the E test.


RESULTS
We identified 55 patients, 52.5% of which were younger than 6 months. The prevalence of penicillin-nonsusceptible strains was 36%. All the strains were intermediately resistant (0.1 microg/ml < or =; MIC < or = 1.0 microg/ml) and 35% of the penicillin intermediate resistant strains were resistant to sulfamethoxazole/trimethoprim. The mortality rate was 20% and impaired neurological outcome was present in 40% of the children. The audiometric test revealed alteration in 60% of the children tested. Age less than 6 months was associated with poor outcome. The most frequent serotypes were 1, 5, 6B, 14, 19A and 23F, and 70% of the serotypes were included in the new 7-valent vaccine.


CONCLUSIONS
These findings suggest that pneumococcal meningitis presents high mortality and morbidity and that the 7-valent conjugate vaccine would be potentially useful in preventing serious pneumococcal infections.
Berezin
Eitan N
EN
Setor de Infectologia Pediátrica, Santa Casa de São Paulo, Brazil. eberezi@zipmail.com.br
Falleiros-Carvalho
Luiza H
LH
Lopes
Claudia R
CR
Sanajotta
Andréia T
AT
Brandileone
Maria Cristina
MC
Menegatti
Sonia
S
Safadi
Marco A
MA
Guerra
Maria Luiza C S
ML