Meningitis without a petechial rash in children in the Hib vaccine era.
OBJECTIVE
(1) To determine the causes of meningitis in children immunized with Hib vaccine, presenting without a non-blanching rash; (2) to review the use of dexamethasone in this group.


METHODS
Retrospective review of all children with more then 10 white cells/mm(3) in their cerebrospinal fluid (CSF), admitted between January 1998 and August 2002. Children were excluded if they had a non-blanching rash on admission or if their discharge diagnosis was not meningitis. Local guidelines recommended dexamethasone to be given before antibiotics for children with meningitis and no rash.


RESULTS
One hundred and eight children were identified. Causes of proven meningitis were: viral 41 (enterovirus 40), bacterial 22. CSF culture or PCR was the only diagnostic test in 31 children. Dexamethasone was given to 16 children. Length of admission was shorter in children with viral compared with bacterial meningitis (4 vs 8 days; P < 0.0001).


CONCLUSIONS
Viral meningitis is the commonest cause of meningitis without rash. Enteroviral PCR was the most useful test and needs to be widely available. Confirmation of enteroviral meningitis allowed early discharge. Few children were given dexamethasone, but only 5/108 may have benefited.


CONCLUSIONS
The most common cause of meningitis without a rash in British children is enterovirus. The use of dexamethasone in children with meningitis without a rash should be reconsidered or, at least, individualised.
Department of Child Health, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK.
N
N
Makwana
K
K
Nye
F A I
FA
Riordan
D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D016667:Bacterial Capsules; D002555:Cerebrospinal Fluid / Q000382:microbiology / Q000821:virology; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000175:diagnosis / Q000503:physiopathology / Q000821:virology; D005260:Female; D006192:Haemophilus Infections / Q000517:prevention & control; D018073:Haemophilus Vaccines / Q000008:administration & dosage*; D006193:Haemophilus influenzae / Q000276:immunology / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology; D008587:Meningitis, Viral / Q000175:diagnosis / Q000503:physiopathology / Q000821:virology*; D016133:Polymerase Chain Reaction; D011135:Polysaccharides, Bacterial / Q000008:administration & dosage*; D011693:Purpura / Q000503:physiopathology
D000893:Anti-Inflammatory Agents; D018073:Haemophilus Vaccines; C044237:Haemophilus influenzae type b polysaccharide vaccine; D011135:Polysaccharides, Bacterial; D003907:Dexamethasone