Culture- and antigen-negative meningitis in Guatemalan children.
OBJECTIVE
To compare children with confirmed bacterial meningitis (CBM) and those with culture- and latex-negative meningitis (CLN).


METHODS
Children 1 to 59 months of age admitted to three major referral hospitals in Guatemala City with clinical signs compatible with bacterial infections were evaluated prospectively between 1 October 1996 and 31 December 2005. Bacterial cultures and latex agglutination antigen testing were performed on samples of cerebrospinal fluid (CSF).


RESULTS
The case-fatality rate was significantly higher in the 493 children with CBM than in the 528 children with CLN (27.6% and 14.9%, respectively; P < 0.001). Children with CBM were less likely to have received antibiotics and more likely to have seizures, shock, or coma on admission than children with CLN. Among the 182 CBM survivors and 205 CLN survivors studied between October 2000 and December 2005, clinically observed sequelae were present at discharge in a higher percentage of the CBM than of the CLN group (78.6% and 46.8%, respectively; P < 0.0001). CSF glucose < 10 mg/dL, peripheral neutrophils < 2 000 cells/mm(3), coma or shock at admission, and concurrent sepsis or pneumonia were risk factors for mortality in children with CBM; only coma or shock at admission predicted mortality in children with CLN.


CONCLUSIONS
The high case-fatality and sequelae rates suggest that many children with CLN may have had bacterial meningitis. Estimates based on confirmed meningitis alone underestimate the true vaccine-preventable disease burden. Additional studies to determine etiologies of CLN in this population are indicated.
Dueger
Erica L
EL
Centers for Disease Control and Prevention, International Emerging Infections Program, PSC 452 Box 115, FPO, AE 09835. edueger@jhsph.edu
Asturias
Edwin J
EJ
Halsey
Neal A
NA
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000382:microbiology; D001419:Bacteria / Q000254:growth & development / Q000276:immunology / Q000302:isolation & purification; D001431:Bacteriological Techniques; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D002555:Cerebrospinal Fluid / Q000166:cytology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000209:etiology; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007841:Latex Fixation Tests; D007964:Leukocytosis / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D012769:Shock / Q000209:etiology
D000900:Anti-Bacterial Agents