Pneumococcal meningitis in childhood: a longitudinal prospective study.
After implementation of programmes for active immunization against Haemophilus influenzae b, Streptococcus pneumoniae and Neisseria meningitidis became the most common agents of bacterial meningitis in childhood. Over a 9-year period, children showing clinical and laboratory findings of meningitis on the basis of their positive cultures of blood or cerebro-spinal fluid (CSF) for S. pneumoniae were enrolled. Predisposing conditions, clinical and laboratory findings, and microbiological and imaging studies were considered. Meningitis-related death or neurological sequelae defined an unfavourable outcome. Sixty-four patients met the inclusion criteria. Thirty-one (48%) children had predisposing conditions to pneumococcal meningitis. Fever and neck stiffness were the main symptoms; 14 patients (22%) reported seizures before admission. Twenty-one patients required treatment in the intensive care unit (ICU). Streptococcus pneumoniae strains were penicillin susceptible in 54 cases (84%). Forty-eight children (75%) showed complete recovery. Two patients (3%) died, and 14 (22%) had sequelae. Patients with a low CSF cell count, low neutrophils, early admission to ICU or infection by penicillin-nonsusceptible strains of S. pneumoniae had an unfavourable outcome more frequently. Low blood neutrophils, low CSF cell count, early admission to ICU and infection by penicillin-nonsusceptible strains are the main factors predicting an unfavourable outcome in children with pneumococcal meningitis.
Pagliano
Pasquale
P
Department of Emergency, I Division of Infectious Diseases, D. Cotugno Hospital, Naples, Italy. ppagliano@libero.it
Fusco
Ugo
U
Attanasio
Vittorio
V
Rossi
Marco
M
Pantosti
Annalisa
A
Conte
Marco
M
Faella
Francesco Saverio
FS
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001769:Blood / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000166:cytology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008137:Longitudinal Studies; D008586:Meningitis, Pneumococcal / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D008826:Microbial Sensitivity Tests; D009422:Nervous System Diseases / Q000382:microbiology; D010406:Penicillins / Q000494:pharmacology; D011446:Prospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D010406:Penicillins